Interactive education system for teaching patient care

ABSTRACT

A newborn simulator for teaching patient care is provided. The newborn simulator includes a body comprising one or more simulated body portions sized to simulate a newborn baby and a head portion movably connected to a portion of the body. A simulated heart is positioned at least partially within the body along with a pair of simulated lungs. The simulator is operable without physical connection to an external device to provide a simulated heart beat and respiratory pattern.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. Ser. No. 11/952,559, now U.S.Pat. No. 8,016,598, filed on Dec. 7, 2007, which is acontinuation-in-part of U.S. Ser. No. 11/538,306, now U.S. Pat. No.7,811,090, filed on Oct. 3, 2006 and a is continuation-in-part of U.S.patent application Ser. No. 10/721,307, now U.S. Pat. 7,192,284, filedon Nov. 25, 2003. The entire disclosures of the foregoing patents andapplications are hereby incorporated by reference.

Further, in some embodiments the present disclosure is configured foruse with the patient simulators and systems described in U.S. patentapplication Ser. No. 11/952,363, now U.S. Pat. No. 7,976,312, filed Dec.7, 2007; U.S. patent application Ser. No. 11/952,606, filed Dec. 7,2007; U.S. patent application Ser. No. 11/952,669, filed Dec. 7, 2007;U.S. patent application Ser. No. 11/952,698, now U.S. Pat. No.7,976,313, filed Dec. 7, 2007, each herein incorporated by reference inits entirety. Further, U.S. patent application Ser. No. 10/848,991, nowU.S. Pat. No. 7,114,954, filed on May 19, 2004; U.S. patent applicationSer. No. 10/292,193, now U.S. Pat. No. 6,758,676, filed on Nov. 11,2002; U.S. patent application Ser. No. 09/684,030, now U.S. Pat. No.6,503,087, filed on Oct. 6, 2000; U.S. patent application Ser. No.09/640,700, now U.S. Pat. No. 6,527,558, filed Aug. 17, 2000; U.S.patent application Ser. No. 09/560,949, now U.S. Pat. No. 6,443,735,filed Apr. 28, 2000; U.S. patent application Ser. No. 09/199,599, nowU.S. Pat. No. 6,193,519, filed Nov. 25, 1998; and U.S. patentapplication Ser. No. 08/643,435, now U.S. Pat. No. 5,853,292, filed May8, 1996 are each hereby incorporated by reference in their entirety.

BACKGROUND

The present embodiment relates generally to an interactive educationsystem for teaching patient care, and more particularly to such a systemhaving virtual instruments for use with a child birthing patientsimulator in conducting patient care activity.

While it is desirable to train students in patient care protocols beforeallowing contact with real patients, textbooks and flash cards lack theimportant benefit to students attained from “hands-on” practice. Thus,patient care education has often been taught using medical instrumentsto perform patient care activity on a simulator, such as a manikin.However, one disadvantage of such a system is that medical instrumentsare often prohibitively expensive, and consequently, many users mustsettle for using a smaller variety of instruments, even at the cost of aless comprehensive educational experience. One solution to the foregoingproblem is using a set of relatively inexpensive, simulated medicalinstruments (“virtual” instruments), as taught in U.S. Pat. No.5,853,292, the entire disclosure of which is hereby incorporated byreference. Another solution is for the simulators to be compatible withreal medical instruments.

Another problem in patient care education is that the patient simulatorsused for teaching a user are generally passive. For example, in a childbirthing simulation, a user must position the simulated fetus in asimulated maternal pelvis, move it down the birth canal, birth thefetus's head, rotate the fetus approximately ninety degrees to birth theshoulders, and finally, pull out the fetus, now referred to as aneonate. While replicating the sequence of events in a real delivery,the lack of verisimilitude resulting from physical manipulation of thefetus by the user undermines an appreciation for the difficulties ofproviding patient care. In a real delivery, the fetus is inaccessible,and most activity is obscured from view, and thus prior systems fail toaddress the most challenging conditions of providing patient care duringchild birthing. Moreover, prior systems fail to simulate cervicaldilation as the fetus moves down the birth canal, thus failing to allowa student to assess the stage of delivery or construct a chart ofcervical dilation versus time to assess the progress of delivery(“Partograph”).

Further, another problem in patient care education is that often thesystems are too bulky and require too many wired connections to othercomponents, which prevents easy transportation of the simulator to otherlocations. Often systems that claim to be “portable” require moving thenumerous attached components, such as compressors and power supplies,for the simulator to be fully-functional. A solution to this problem isto make the simulators fully-functional, self-contained simulators thatcommunicate with external devices wirelessly. Therefore, what is neededis a system for an interactive education system for use in conductingpatient care training sessions that includes a more realistic simulatedpatient(s).

SUMMARY

The present embodiment provides an interactive education system forteaching patient care to a user. The system includes a maternalsimulator, a fetal simulator designed to be used both in conjunctionwith the maternal simulator and separate from the maternal simulator,and neonatal simulator designed to replace the fetal simulator inpost-birth simulations. In some embodiments, the system includessimulators that are completely tetherless. That is, the simulator isfunctional without the need for wired connections to other externalinstruments, devices, or power supplies. In such embodiments, thesimulator may communicate with other devices or instruments wirelessly.

In some embodiments, a newborn simulator for teaching patient care isprovided. The simulator includes a body having one or more simulatedbody portions sized to simulate a newborn baby. A head portion ismovably connected to a portion of the body. A simulated heart andsimulated lungs are positioned at least partially within the body. Thesimulator is operable to provide a simulated heart beat and respiratorypattern. Also, the simulator is operable without physical connection toan external device.

In some embodiments, a method of teaching patient care is provided. Themethod includes providing a medical simulator including a model of atleast a portion of a human body. The simulator is configured to executea simulated medical scenario. The method also includes defining aplurality of palette items, each of the plurality of palette itemsassociated with a physiological state of the simulator, and defining atleast one scenario, the at least one scenario including a series oflinked palette items. The method also includes selecting a scenario forexecution by the simulator, communicating the selected scenario to thesimulator, and utilizing the simulator to execute the selected scenario.

In some embodiments, a patient simulator for teaching patient care isprovided. The simulator includes a patient body comprising one or moresimulated body portions and a pair of bladders positioned within thepatient body for simulating a patient's lungs. A compressor ispositioned within the patient body in communication with the bladdersfor selectively providing an air supply to the bladders to simulate arespiratory pattern. A master module is also positioned within thepatient body and configured for communication with an external controlsystem. A respiratory module system is positioned within the patientbody and spaced from the master module. The respiratory module systemcontrols the respiratory pattern of the patient simulator by controllingthe air supply to and from the bladders. The patient simulator isoperable without physical connection to an external device.

In some embodiments, a patient simulator for teaching patient care isprovided. The simulator includes a patient body simulating at least aportion of a patient's anatomy. A master module is positioned within thepatient body. The master module is configured for communication with anexternal control system. In that regard, the master module is configuredto receive simulation commands from the external control system andrelay the simulation commands to a plurality of task modules positionedwithin the patient body but spaced from the master module. The simulatoralso includes the plurality of task modules configured to execute thesimulation commands received from the master module.

In some embodiments, an eye assembly for use in a patient simulator isprovided. The eye assembly includes an iris diaphragm having a moveableinner portion defining an opening. The inner portion of the irisdiaphragm is movable radially from a first position wherein the openinghas a first diameter and a second position wherein the opening has asecond diameter greater than the first diameter. The iris diaphragm isconfigured for use in a simulated eye. The eye assembly also includes adilation actuator in communication with the inner portion of the irisdiaphragm for selectively moving the inner portion between the first andsecond positions to simulate dilation of an eye.

In some embodiments, a patient simulator system for teaching patientcare is provided. The system includes a patient simulator. The patientsimulator includes a patient body comprising one or more simulated bodyportions. A respiratory system is positioned within the patient body.The respiratory system includes a pair of lungs and is configured tosimulate a respiratory pattern of a patient. A circulatory system isalso positioned within the patient body. The circulatory system isconfigured to simulate at least one circulatory parameter of thepatient. The system also includes a control system in communication withthe patient simulator. The control system includes a respiratoryphysiological model for controlling the simulated respiratory pattern ofthe respiratory system and a circulatory physiological model forcontrolling the at least one circulatory parameter of the circulatorysystem. The respiratory physiological model is configured to adjust thesimulated respiratory pattern of the respiratory system at leastpartially based on a treatment administered to the patient simulator bya user.

In some embodiments, a patient simulator system for teaching patientcare is provided. The system includes a maternal simulator comprisingone or more simulated body portions, a fetal simulator positioned withinthe maternal simulator, and a control system in communication with thematernal and fetal simulators. The control system is configured forcontrolling simulated physical parameters of the maternal simulator andthe fetal simulator. In that regard, parameters of the fetal simulatorare at least partially based on parameters of the maternal simulator.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 a is a schematic view of an illustrative embodiment of aninteractive education system.

FIG. 1 b is a schematic view of an interactive education systemaccording to another embodiment.

FIG. 2 is a schematic view of the interaction between a set of virtualinstruments and a patient simulator.

FIG. 3 a is a perspective view with a cutaway of a virtual instrument.

FIG. 3 b is a perspective view with a cutaway of a sensor.

FIG. 4 is a perspective view of an illustrative embodiment of a patientsimulator.

FIG. 5 a is a perspective view of the patient simulator of FIG. 4 withan attached cover.

FIG. 5 b is a top plan view of a control box.

FIG. 6 is a perspective view of the torso of the patient simulator ofFIG. 4.

FIG. 7 is a perspective view of FIG. 6 with the fetal portion of thepatient simulator removed.

FIG. 8 is a perspective view of a distensible cervix of the patientsimulator.

FIG. 9 is a perspective view of the exterior of the patient simulator.

FIG. 10 is a perspective view of a neonatal embodiment of a patientsimulator.

FIG. 11 is a schematic view of an illustrative use of the presentsystem.

FIGS. 12-16 are screen display views generated by a program according toone embodiment of the present system.

FIG. 17 is a perspective view of a neonatal embodiment of a patientsimulator according to one embodiment of the present disclosure.

FIG. 18 is a perspective view of various modules for use with theneonatal simulator of FIG. 17.

FIG. 19 is a perspective view of a cutaway portion of the neonatalsimulator of FIG. 17.

FIG. 20 is schematic view of an air supply system of the neonatalsimulator of FIG. 17.

FIG. 21 is a perspective view of a cutaway portion of a muffler for usewith the air supply system of FIG. 20.

FIG. 22 is a screen display view generated by a program according to oneembodiment of the present disclosure.

FIG. 23 is an output display view of simulated vital signs of theneonatal simulator of FIG. 17 according to one embodiment of the presentdisclosure.

FIG. 24 is a front view of a mechanism for securing the fetal/neonatalsimulator to the maternal simulator according to one embodiment of thepresent disclosure.

FIG. 25 is a perspective, exploded view of the mechanism of FIG. 24.

FIG. 26 is a perspective view of a portion of the mechanism of FIG. 24.

FIG. 27 is a perspective view of another portion of the mechanism ofFIG. 24.

FIG. 28 is a side view of a system for causing selective rotation of thefetal/neonatal simulator during a birthing simulation.

FIG. 29 is a diagrammatic schematic view of a patient simulator systemaccording to one embodiment of the present disclosure.

FIG. 30 is a diagrammatic schematic view of a patient simulator systemaccording to another embodiment of the present disclosure.

FIG. 31 is a diagrammatic schematic view of a patient simulator systemaccording to another embodiment of the present disclosure.

FIG. 32 is a diagrammatic schematic view of a master module for use in apatient simulator system according to one embodiment of the presentdisclosure.

FIG. 33 is a diagrammatic schematic view of a communication module foruse in a patient simulator system according to one embodiment of thepresent disclosure.

FIG. 34 is a diagrammatic schematic view of a communication module foruse in a patient simulator system according to another embodiment of thepresent disclosure.

FIG. 35 is a diagrammatic schematic view of a pneumatic module for usein a patient simulator system according to one embodiment of the presentdisclosure.

FIG. 36 is a diagrammatic schematic view of an audio module for use in apatient simulator system according to one embodiment of the presentdisclosure.

FIG. 37 is a diagrammatic schematic view of a sensing module for use ina patient simulator system according to one embodiment of the presentdisclosure.

FIG. 38 is a diagrammatic schematic view of a sensing driver module foruse in a patient simulator system according to one embodiment of thepresent disclosure.

FIG. 39 is a diagrammatic schematic view of an ECG module for use in apatient simulator system according to one embodiment of the presentdisclosure.

FIG. 40 is a diagrammatic schematic view of a Pacer/Defib module for usein a patient simulator system according to one embodiment of the presentdisclosure.

FIG. 41 is a diagrammatic schematic view of a motor driver module foruse in a patient simulator system according to one embodiment of thepresent disclosure.

FIG. 42 is a diagrammatic schematic view of an intubation module for usein a patient simulator system according to one embodiment of the presentdisclosure.

FIG. 43 is a diagrammatic schematic view of an inflation/deflationmodule for use in a patient simulator system according to one embodimentof the present disclosure.

FIG. 44 is a diagrammatic schematic view of a patient simulator systemaccording to one embodiment of the present disclosure.

FIG. 45 is a diagrammatic schematic view of a patient simulator systemaccording to another embodiment of the present disclosure.

FIG. 46 is a front view of an eye assembly for use in a patientsimulator according to one embodiment of the present disclosure.

FIG. 47 is a front view of an iris diaphragm of the eye assembly of FIG.46 according to one embodiment of the present disclosure.

FIG. 48 is a bottom view of the eye assembly of FIG. 46.

FIG. 49 is a diagrammatic schematic view of the blinking assembly of theeye assembly of FIG. 46.

FIG. 50 is a diagrammatic perspective view of a delivery mechanism foruse in a patient simulator according to one embodiment of the presentdisclosure.

FIG. 51 is a diagrammatic perspective view of a delivery mechanism foruse in a patient simulator according to another embodiment of thepresent disclosure.

DETAILED DESCRIPTION

Referring to FIG. 1 a, the reference numeral 10 refers, in general, toan interactive education system for teaching patient care protocols to auser. The system 10 comprises a set of virtual instruments 12 used tosimulate medical instruments, and a simulator 14 used to simulate atleast one patient for receiving patient care activity from the user. Thevirtual instruments 12 are tangible objects, and look, feel, and operatelike real medical devices in conjunction with the simulator 14, which isunderstood to encompass a variety of forms, including a fullyarticulating and adult-sized manikin, as well as a fetus, a neonate, achild, a youth, or portion of a manikin, such as the arm, torso, head,or pelvic region.

Patient care activity received by the simulator 14 from the user, orusers, is sensed in a manner to be described, and in response to theactivity, the system 10 provides feedback to the user. It is understoodthat feedback may comprise any audio, visual, or tactile response. Acomputer 15 having a program 15 a is optionally connected to the system10, for reasons to be described.

Referring to FIG. 1 b, a system 10′ comprises the computer 15 and theprogram 15 a, wherein a software-generated set of virtual instruments12′ and a software-generated simulator 14′ is provided. Thus, thepatient care activity performed by the user comprises manipulating anicon relating to a selected software-generated virtual instrument 12′ toprovide patient care to the software-generated simulator 14′. In thisembodiment, the program 15 a uses conventional means, such as clicking amouse or voice-activated software, to monitor activity by the user, andprovides feedback in response, as will be described.

Returning to FIG. 1 a, the system 10 further comprises a communicationsinterface module (“CIM”) 16, which receives operating power from aconventional power source 18, and contains a microcontroller (“PIC”) 20.Microcontrollers are available from many vendors, such as MicrochipTechnology, Inc. (Chandler, Ariz.), and are then customized. As will bedescribed, the PIC 20 receives input signals from the user's activity,and is programmed to respond in a certain manner to provide feedback tothe user. For example, to provide audio feedback, the CIM 16additionally includes an audio chip 22 which is responsive to the PIC 20for causing a speaker 24 to produce realistic patient sounds, forexample, heart, lung, blood pressure (Korotkoff), intestinal, fetal, andthe like. A control 26 is included in the CIM 16 for adjusting thevolume of the speaker 24.

Alternatively, depending on the complexity of the desired feedback, theCIM 16 may be connected to the computer 15 and program 15 a. In oneexample of feedback, the program 15 a could be used to provide a vastlibrary, for example, of ultrasound profiles, or fetal distress monitortraces. Feedback could also be of body sounds, generated by the program15 a, and played through speakers of the computer.

The CIM 16 has a plurality of ports, collectively 28, for receivinginput signals occasioned by interaction between the virtual instruments12 and sensors 30 disposed on the simulator 14, resulting from theuser's patient care activity. It is understood that there may be morethan one PIC 20, and more than one CIM 16, to manage the input signalsthus created.

The virtual instruments 12 comprise patient care devices, for example,as shown in FIG. 2, at least one IV needle, an endotracheal (ET) tube,an electrocardiogram (ECG or EKG) monitor, a blood pressure (BP) cuff, apulse oximeter cuff, a temporary external pacer, an automatic externaldefibrillator (AED), a manual defibrillator, an ultrasound wand, avirtual stethoscope, a thermometer, and a fetal distress monitor,respectively 12 a-l. Such virtual instruments look and operate like realmedical devices. Of course, other virtual instruments are contemplated,as is the use of relatively inexpensive medical devices, such as aconventional stethoscope, a vacuum extractor, catheters, trays, IVstands, and the like.

Referring to FIG. 2, the IV needle 12 a has a selectable group ofspecific drugs and dosages, and in one embodiment is part of amedication tray with an assortment of labeled syringes for dispensingthe drugs to the simulator 14, with the effects of administrationcontrolled by the program 15 a. The ET tube 12 b is used in simulatedpatient airway management, and placed in a tracheal airway of thesimulator 14. The EKG monitor 12 c comprises a 3, 5, or 12 lead system,including a real-time trace monitor and R-wave sonic markers, and aplurality of color-coded patches for attachment to a torso of thesimulator 14. The BP cuff 12 d attaches to the simulator 14, forexample, around an arm. The pulse oximeter finger cuff 12 e attaches tothe simulator 14, for example, around a finger. The temporary externalpacer 12 f has a plurality of anterior and posterior pacer pads forattachment to the torso of the simulator 14. The pacer 12 f has controlsfor pacer rate and current, and exhibits rhythm pacing, cap time, andloss of cap time, all of which is controlled by the program 15 a. Theautomatic external defibrillator (AED) 12 g has a plurality of apex andsternum AED pads for attachment to the torso of the simulator 14. Uponselecting a software-generated shock button produced by the program 15a, the system 10 simulates defibrillation shock, with the resultantconditions controlled by the program 15 a. The manual defibrillator 12 hhas a plurality of apex and sternum defibrillator paddles for contactingthe torso of the simulator 14. Upon selecting a software-generated shockbutton, or alternatively by using a dual shock buttons associated withmanual defibrillator 12 h, the system 10 simulates defibrillation shock,with the resultant conditions controlled by the program 15 a.

Still referring to FIG. 2, the ultrasound wand 12 i interacts with thesimulator 14, such that when the wand 30 i is brought within apredetermined proximity of a predetermined anatomical area of thesimulator, the CIM 16 detects the interaction and the program 15 asupplies an ultrasound profile taken from a library of ultrasound imagesand or sounds. The program 15 a may select between normal and abnormalprofiles, requiring the user to interpret the profile and respondaccordingly. The virtual stethoscope 12 j interacts with the simulator14, such that when the stethoscope 12 j is brought within apredetermined proximity of a predetermined anatomical area of thesimulator, the CIM 16 detects the interaction and feedback is suppliedto the user, as will be explained below, with FIGS. 3 a-b. Thethermometer 12 k interacts with the simulator 14, such that when thethermometer 12 k is brought within a predetermined proximity of apredetermined anatomical area of the simulator, the CIM detects theinteraction and the program 15 a supplies a temperature reading. Thefetal distress monitor 12 l (tocodynomometer) attaches to a portion ofthe simulator 14, and upon attachment, the program 15 a supplies a heartrate reading for a simulated fetus.

Each instrument has a corresponding sensor 30 a-l, as indicated bylines, collectively 36. Unless otherwise indicated, the lines 36 areschematic, and merely illustrate that the virtual instruments 12 and thesensors 30 are functionally connected to each other for providing aninteraction created by the user's patient care activity, the interactionbeing reported as an input signal to the CIM 16. It is understood thatthe sharing of such physical lines among instruments 12, or sensors 30,is contemplated as well.

Interaction between the virtual instruments 12 and the sensors 30 may beelectrical, optical, pressure differential, tactile,temperature-controlled, or wireless. Generally speaking, an electricalinteraction (which would also provide the input signal) could be createdvia a virtual instrument 12 having one node and a sensor 30 with anothernode, both of which are physically connected to the CIM 16, or by avirtual instrument with two nodes and a sensor formed of conductivematerial, or vice versa, only one of which may be physically connectedto the CIM 16. For example, the IV needle 12 a corresponds with aportion of the simulator 14 capable of accepting medications, such asthe antecubital region of an arm, which may have a sensor 30 acomprising an insulator sandwiched between two layers of conductivematerial having an appropriate thickness and weave density forpermitting the needle 12 a to pass through the cloth at a low acuteangle (e.g., 20□). The conductive layers of the sensor 30 a areelectrically coupled to the CIM 16 via line 36 a′, such that when theneedle 12 a is correctly passed through the two conductive layers,simulating cannulation of a vein of the simulator 14, a circuit iscompleted between the layers and sensed by the CIM 16.

In another example of a method of sensing interaction, the ET tube 12 bis used in simulated patient airway management, the simulator 14 havinga head, eyes, a nose, a mouth, and a realistic airway capable ofaccepting conventional airway adjuncts, with the airway configurationadjustable to display a large tongue, an obstructed pharynx, or closedvocal cords, to increase the difficulty of the patient care activity. Inorder to confirm proper placement in the tracheal airway of thesimulator 14, an optical sensor 30 b is mounted in the wall of thetrachea of the simulator 14 and connected to the CIM 16 via line 36 b′.Correct placement of the ET tube 12 b in the trachea is confirmed whenthe tip of the ET tube interrupts the beam of the optical sensor 30 b.The sensor 30 b may also be used to determine whether a fluid haspassed.

The virtual stethoscope 12 j provides an example of a wireless method ofsensing interaction. At least one sensor 30 j is placed at an anatomicallocation on the simulator 14 where specific heart, lung (includingairway), Korotkoff, fetal, or other sounds are normally heard. Thesensor 30 j provides at least one signal which is identified by thestethoscope 12 j, thereby directing an integrated sound circuit to playa sound to the user appropriate for the anatomical location of thesensor on the simulator 14. It is understood that the sound circuit hasa stored library of body sounds corresponding to the location of theselected sensor 30 j, and that the sensor 30 j is illustrative of anynumber of similar sensors.

Referring to FIG. 3 a, in some respects, the appearance of thestethoscope 12 j resembles a standard stethoscope, having earpieces 50a-b for hearing sounds, and being connected to extenders 51 a-b, whichare joined to a bifurcated ear tube 52. Similarly, the stethoscopefurther comprises a bell tube 54, and a bell 56, preferably made ofnonferrous material. However, unlike conventional stethoscopes, anelectronic control box 58 is disposed between the ear tube 52 and thebell tube 54. The control box 58 is understood to be an appropriatelydeveloped CIM 16, physically integrated into the virtual instrument 12j, thus simplifying the system 10. A jack 64 is provided on the controlbox 58 for output to an external speaker (not depicted), so that otherusers may hear the sounds heard in the earpieces 50 a-b. This not onlyincreases the number of users who benefit from the patient careactivity, but allows an instructor to test the user's ability, andcorrect the user's technique if required. The control box 58 retains asmall power source 66, such as a battery, an acquisition circuit 68 anda sound circuit 70 (see copending U.S. application Ser. No. 09/640,700,filed Aug. 17, 2000, for circuit diagrams) for directing a small speaker72, such as is available from ADDAX Sound Company (Northbrook, Ill.), toplay a predetermined sound. The speaker 72 is disposed in the earpiece50 a, and connected to the control box 58 via a wire 72 a, allowing theuser to hear the sounds produced by the sound circuit 70. It isunderstood that a second, substantially identical speaker may bedisposed in the opposite earpiece 50 b, and also connected to thecontrol box 58. In an alternative embodiment, the speaker 72 may bedisposed in the control box 58, and sounds transmitted via conventionalear tubes to the ear pieces. The sound circuit 70 is also connected tothe jack 64 for allowing connection to an external speaker for theabove-described reasons.

A switch 74, having a number of positions, is disposed on the controlbox 58 for switching between groups of sounds, for example exemplarynormal and abnormal sounds that may be those heard in an adult, neonate,or fetus. An RF (radio frequency) signal acquisition coil 76, such as isavailable from M.C. Davis Co. (Arizona City, Ariz.), is disposed in theinterior of the bell 56 for transmitting and acquiring RF signals, aswill be explained. The acquisition coil 76 is a copper coil andcircuitry having an associated wire 76 a, which is attached to theelectronic control box 58. A polymeric disc 78 is disposed between theacquisition coil 76 and the bell 56 to decrease noise from the bell.

In other embodiments, the sounds are recreated by speakers (not shown)disposed within the manikin such that the sounds are audible without theuse of a real or virtual stethoscope. In yet other embodiments, thesounds are recreated by speakers (not shown) disposed within the manikinsuch that the sounds are audible with the use of a real stethoscope.

Referring to FIG. 3 b, the sensor 30 j is disposed beneath the skin 14 bof the simulator 14 to avoid visual detection by the user. Likewise, itis advantageous that the sensor 30 j have a minimal thickness to preventintentional or accidental detection, as some anatomical locations, forexample, intercostal spaces, must be palpated in order to be located. Inan alternative embodiment, the sensors 30 j may be affixed to an overlay(not depicted) substantially similar to the skin 14 b, thus allowing theoverlay to be placed over other simulators and models of patients,thereby converting those devices to allow them to be used with thestethoscope 12 j.

The sensor 30 j comprises an RF ID tag 80, such as is available fromMicrochip Technology, Inc. (Chandler, Ariz.) (Part No. MCRF200-I/3C00A),which may be programmed using “Developer's Tools” also sold by MicrochipTechnology, Inc. to engender a unique signal that serves to identify theparticular sensor 30 j. A coil 82, such as is available from M. C. DavisCo. (Arizona City, Ariz.), is operably connected to the tag 80. The tag80 and coil 82 are potted in RTV potting material 84, or silicon rubber,such as is available from M. C. Davis Co. (Arizona City, Ariz.), toprevent damage. Once potted, the tag 80 and coil 82 collectively form aCOB module 86 which emits a signal comprising a unique train offrequencies when interrogated.

In operation, the COB module 86 may actively broadcast the frequencies,but preferably the COB module is passive, that is, only activated wheninterrogated by the acquisition coil 76 in the stethoscope bell 56. Inthis preferred embodiment, the acquisition coil 76 delivers a carriersignal, such as a 125 kHz excitation frequency, which is received by theCOB module 86 when the bell 56 is brought within a predeterminedproximity, or acquisition distance, of the COB module. The acquisitiondistance of the bell 56, and therefore the acquisition coil 76, to theCOB module 86 is determined by the strength to noise (S/N) ratio of thecarrier signal. Thus, adjustment of the S/N ratio of the carrier signalprovides a means for controlling the precision with which the user mustplace the stethoscope bell 56 in relation to the anatomical location ofthe sensor 30 j, and therefore the COB module 86. Precise placement ofthe bell 56 on the simulator 14 by the user is rewarded with feedback,in the form of an appropriate body sound. Normally, the S/N ratio is setto require that the bell 56 be brought within approximately one-half totwo centimeters of the COB module 86 of the sensor 30 j.

In response to receiving a sufficiently strong carrier signal, the COBmodule 86 emits a train of two identifying frequencies for use in aprocess conventionally known as frequency shift keying (FSK), althoughother keying methods could be used. The acquisition coil 76 in thestethoscope bell 56 receives the emitted frequencies and relays thesignal to the acquisition circuit 68, which determines the identity ofthe sensor 30 j. As the anatomical position of each sensor 30 j is knownto the programmer, a selection of appropriate body sounds associatedwith each sensor is provided, and accessible to the sound circuit 70.Thus, by identifying the sensor 30 j, the acquisition circuit 68 directsthe sound circuit 70 to play an appropriate body sound for theanatomical position of the COB module 86, which is heard by the userthrough the speaker 72 disposed in the earpiece 50 a. It can beappreciated that to expose the user to a greater selection of sounds,more sensors 30 j could be added to the simulator 14, or each sensorcould correspond to more than one sound. As depicted, the switch 74 hasfive different positions, and includes means for switching the soundcircuit 70 between five different groups of sounds. Thus, it isunderstood that the number of switch positions corresponds to the numberof sounds that can be produced by a single sensor, i.e., with thirteensensors and five switch positions, the user could listen to up tosixty-five location-appropriate sounds, including examples of normal andabnormal sounds.

It can be appreciated that the above-described acquisition coil and COBmodule may be adapted to be used with the respective leads, paddles, orprobes (“connectors”) of the ECG monitor 12 c, the temporary externalpacer 12 f, the automatic external defibrillator (AED) 12 g, the manualdefibrillator 12 h, the ultrasound wand 12 i, and the fetal distressmonitor 12 l. If desired, the connectors may be equipped with adhesiveto temporarily hold them in place on the patient simulator. Theinteraction between the instruments' connectors and the sensors 30, assensed by the CIM 16, confirms proper placement. The hidden location ofthe sensors 30 beneath the skin of the patient simulator furtherchallenges a user's patient care skills, as well as more closelymimicking a real patient.

It is understood that the simulator 14 is designed to represent apatient and receive treatment, and as such the simulator 14 could take avariety of forms, including a fully articulating and adult-sizedobstetrics simulator, a curled fetus, an articulating fetus, multiplefetuses, or a neonate, as well as a portion of simulated patient, forexample, the torso and pelvic region.

Referring to FIGS. 4 and 5 a, in an illustrative embodiment, thesimulator 14 comprises a child birthing maternal simulator 300 and aremovable associated fetal simulator 302. The maternal simulator 300 hasa head 304, with hair 306, eyes 308 a-b, a nose 310, and a mouth 312.The head assembly contains a realistic airway (not depicted) capable ofaccepting conventional airway adjuncts. Sensors, generally denoted 30(FIG. 1 a), may be disposed on the skin of the maternal simulator (shownas stippled) and/or beneath the skin (shown in phantom). It isunderstood that in one embodiment of the maternal simulator (notdepicted), no sensors are associated with the simulator. Lines 36protrude from the torso 316 for providing electrical, pneumatic, orfluid connections, as well as for connecting the sensors 30 to the CIM16, if necessary.

In other embodiments, the maternal simulator 300 is tetherless. That is,the maternal simulator is functional without wired or tubular connectionto other devices outside of the simulator and, therefore, does not havelines 36, 325 a, and 326 b extending from the torso 316. Rather, thematernal simulator is self-contained. Thus, the maternal simulator 300can include an internal power supply, such as a rechargeable power cell,and all pneumatic and fluid connections are made to the correspondingcompressors or other devices within the maternal simulator 300. As thematernal simulator is self-contained, it is not only portable, but canbe in use while being transported between different locations. Further,in such embodiments, the maternal simulator 300 may communicate withother devices, such as the CIM 16, through wireless communication. Thus,the entire simulator system 14 can be functional up to the limits of thewireless communication. Further, in some embodiments the maternalsimulator 300 may connect to a computer or network system wireless,which then connects to the CIM 16 via a wired or wireless network,making the functional distance of the maternal simulator virtuallylimitless. Though only the maternal simulator has been described here asbeing self contained, the fetal and neonatal simulators described inmore detail below are also tetherless in some embodiments. In someembodiments, the simulators are configured to be used both un-tetheredand tethered. In some embodiments, the simulators are fully-functionalwhen used un-tethered (i.e., the simulator has the same functionalitytethered and un-tethered.)

A pair of arms 318 a-b are connected to the torso 316. At least one armcontains an IV receptacle (not depicted) capable of acceptingmedications, and sensors 30 a may be placed within the receptacle toascertain whether an IV has been started. Similarly, the arm may containa sensor 30 d for auscultation of Korotkoff sounds, as well as means formeasurement of blood pressure. A pelvic region 320 of the torso 316receives a pair of legs 322 a-b.

Referring to FIG. 5 a, a cover 324 may be attached to the torso 316 viaa plurality of snaps 324 a, although other reversible fastening means,such as hook and loop closures may be used. The cover 324 retainssensors 30, for cooperating with the ultrasound wand 12 i, fetaldistress monitor 12 l, and the stethoscope 12 j, or alternatively atleast one small speaker, to allow simulation of fetal heart sounds whichmay be detected by the stethoscope 12 j or a conventional stethoscope,respectively. In one embodiment, the cover 324 surrounds an open cellfoam (not depicted) connected to means for producing a vacuum.Activation of the vacuum shrinks the foam, making it feel harder, whichsimulates uterine contractions by the maternal simulator 300.Alternatively, the cover 324 may retain an air bladder and associatedline (not depicted) for pressurizing the cover, thus making it feelharder. In yet other embodiments, the cover may contain a plurality offlexible tubes (not shown) extending across the torso. The air pressurein the tubes determines the hardness. The pressure is adjusted to changethe hardness. It is understood that different levels of hardness may beproduced to simulate different levels of contraction strength, forexample, mild, moderate, and strong contractions. If connected to theCIM 16 and program 15 a, the contractions could be spaced at regularintervals, and associated data for maternal intrauterine pressure may bedisplayed by the program, as will be discussed with FIG. 14.

Returning to FIG. 4, the fetal simulator 302, has an umbilical cord 302a and placenta 302 b, and is depicted as resting upon a removable stage325 disposed inside the maternal simulator. The removable stage 325 hasa bladder (not shown), a line 325 a, and a bulb 325 b. When the bulb 325b is used to pump air into the bladder, the stage 325, and hence thefetal simulator 302, is raised relatively upwards. When covered with thecover 324 (FIG. 5 a), raising of the stage 325 allows a user to palpatethe fetal simulator 302 through the cover to assess position, as well asto perform Leopold maneuvers. In other embodiments, the bulb 325 b isreplaced by an alternative pump, such as an electrically powered,pneumatic pump. The electric pump may be controlled remotely through acomputer system or other device.

A birthing device 326 is disposed inside the torso 316, as will bedescribed. The cover 324 is designed to obscure the fetal simulator 302of the simulator and the birthing device 326 from view, thus moreaccurately simulating the child birthing process, and challenging theuser's diagnostic abilities. With the stage 325 removed, the birthingdevice 326 may be operated via a manual crank (not shown), or by a smallmotor 326 a connected via a line 326 b to controlling means for turningthe motor on or off, as well as determining operational speed.

In a first embodiment, software of the program 15 a controls thebirthing device 326, as will be discussed in conjunction with FIG. 14,below. In an alternative embodiment, the controlling means is a controlbox 328, and a line 330 which connects the control box 328 to the CIM16. Referring to FIG. 5 b, the control box 328 has controls 328 a-d forrespectively turning the simulator 14 on and off, pausing and resumingchild birthing, determining the speed of the delivery rate, and settingthe fetal heart rate.

Referring to FIGS. 6 and 7, the torso 316 of the maternal simulator 300is shown with the cover 324 removed to expose the fetal simulator 302.The fetal simulator 302 is disposed in a cavity 333 of the maternalsimulator 300, and has a head 334, an attached torso 336, with a pair ofarms 338 a-b and legs 340 a-b attached to the torso. The head 334 issoft to allow for vacuum extraction, and has a mouth and nose which maybe suctioned by the user.

In that regard, in some embodiments the fetal simulator 302 includesforce sensors (not shown) positioned in the neck, shoulders, and hips tomonitor the amount of force being applied on the fetal simulator duringdelivery. Pulling on the head 334 produces a signal from the necksensor. The amount of force is relayed to the user and/or instructor bya user interface. The user interface can include a graphical display oraudible signals. For example, the user interface may produce a bar graphindicating the amount of force being applied or the user interface maybeep or otherwise sound an alarm when the force exceeds a predeterminedthreshold, prompting the user to reduce the force being applied or try adifferent delivery method. In one embodiment, the maximum forcethreshold is approximately 40 lbs. of force. In one embodiment, thepreferred range of force is between approximately 17-20 lbs. of force.Shoulder dystocia is a potentially fatal situation wherein the shoulderof the fetus becomes lodged behind the maternal pubic bone. Too muchforce can lead to brachial plexis and even Erb's palsy in the fetus. Tosimulate this potential situation, shoulder sensors are included at theleft and right shoulders of the fetal simulator 302 to monitor the forcebeing applied at the shoulders. Finally, various situations, such asvaginal breeches, can cause the legs 340 a-b to be grasped and removedfrom the vagina. The hip sensors serve to monitor the force beingapplied to the fetal simulator 302 in such situations. In someembodiments, the sensors 30 are in communication with an output deviceoperable to provide output signal indicative of the measurement aparticular sensor is adapted to monitor. The output device may output anelectrical signal, wireless signal, or any other suitable output signal.

The umbilical cord and placenta 302 a-b (FIG. 4) are removed to simplifythe illustration, but it is understood that the placenta 302 b (FIG. 4)could be disposed in any number of common orientations, such as normalfundal, low placement, or placenta previa, and attached to the cavity333 with conventional removable fasteners. Likewise, the umbilical cord302 a (FIG. 4) could be presented to replicate various complications,and may house connecting lines to the fetal simulator 302 to allow anumbilical pulse to be felt by the user, or to convey electricity to thefetal simulator 302, if necessary.

A receiver 342 is disposed on the fetal simulator 302 to allow thebirthing device 326 to retain the fetal simulator. Other receivers,similar to the receiver 342, are contemplated on different portions ofthe fetal simulator 302, such as to simulate a breech birth, and as thefetal simulator 302 articulates, a variety of breech deliveries, such asfull, frank, and footling may be simulated.

The birthing device 326 has a projection 344 of a ram 346 whichcooperates with the receiver 342 of the fetal simulator 302 to retainthe fetal simulator. In some embodiments, the receiver 342 andprojection 344 are adapted for selective engagement such that the fetalsimulator 302 is selectively engaged with or released by the maternalsimulator 300. In the depicted embodiment, the ram 346 is driven by adrive system, including a small electric motor, gears, electronic logicto permit resetting, means to determine the position of the ram, and aforward and reverse function. The ram 346 proceeds down a set of tracks347 a-b, thereby translating the fetal simulator 302 out of the maternalsimulator 300.

The projection 344 of the ram 346 is rotatable, the birthing device 326thereby producing both rotational and translational movement of fetalsimulator 302, to simulate a realistic child birthing scenario, whereinthe fetus makes a turn to bring it to a normal nose down position ofcrowning, and it makes another turn after crowning to allow itsshoulders to better pass through the birth canal. In some embodiments,the receiver 342 is disposed in another portion of the fetal simulator,such as the head, neck, shoulders, arms, hips, and/or legs. Alternativeembodiments of the receiver 342 and projection 344 are discussed inrelation to FIGS. 24-27 below.

In one embodiment, levers 346 a-b of the ram 346, being operablyconnected to the projection 344, engage cams 348 a-b, respectively, toproduce rotation. As the ram 346 proceeds down the tracks 347 a-b, thelevers 346 a-b of the ram engage the fixed cams 348 a-b in turn, causingthe respective lever to move. Movement of the lever rotates theprojection 344. Eventually, the respective lever is moved to a pointwhere the lever clears the respective cam. It can be appreciated thatthe cams 348 a-b may be located at places along the tracks 347 a-b whererotation is desired, the tracks simulating the birth canal. Thus,internal rotation of the fetus is produced by the lever 346 a engagingthe cam 348 a, and external rotation of the fetus is produced by thelever 346 b engaging the cam 348 b. As described below in relation toFIG. 28, in some embodiments the cams 348 a-b are moveable between aposition for causing rotation of the fetal simulator and a position thatdoes not cause rotation of the fetal simulator. Further, in someembodiments the cams 348 a-b include intermediate position(s) to providesome rotation to the fetal simulator. Alternatively, the program 15 aallows for adjustment of the rotation of the projection 344 from zero toone hundred and eighty degrees, as will be discussed with reference toFIG. 14, below. In either embodiment, the fetus 302 passes through adistensible cervix 350, as will be described.

Referring now to FIGS. 8 and 9, the distensible cervix 350 comprises aring 352 having attached flaps 353 a-b for maintaining the cervix'sposition in the cavity 333. As such, the flaps 353 a-b may have attachedsnaps, hook and loop closures, or other reversible fastening means. Awall 354 is connected to the ring 352, and is preferably of an elasticmaterial, such as Lycra⁷, or thermoplastic elastomer. A gathering 356 ofthe wall material defines a port 358. The gathering 356 may have anassociated elastomeric element disposed interiorly to enhance theelasticity of the port 358. Alternatively, the wall 354 itself mayprovide sufficient elasticity.

The port 358 expands from about two to ten centimeters in diameter asthe fetal simulator 302 is pushed through the port, and because of theshape of the fetal simulator's head 334, and the elasticity of the wall354, dilation is automatically simulated coincident to fetal descent.The user may then practice measuring cervical dilation and plot laborprogress as a Partograph. The elasticity of the wall 354 may beadjusted, for example by using thicker or thinner wall material, toproduce a cervix having faster or slower dilation than normal,respectively. The cervix 350 is disposed concentric to the pelvic area320, which has a pubic bone 360, as well as several cover snaps 324 a.

The fetal simulator 302 moves through the cervix 350 and out of thecavity 333 past vulva 362. The vulva 362 are made of a flexible materialso that the user may manipulate the vulva, or perform an episiotomy tobirth the head 334. It is understood that the vulva 362 may comprise aportion of an insert (not depicted) including features such as a urinarytract and rectum, which could be replaceable with other genital insertsfor displaying various patient conditions. After delivery, the user maypractice postpartum exercises, such as massaging a uterus insert (notdepicted) back to a desirable size, removing retained placenta parts(not depicted), or repairing the cervix 350 or vulva 362.

In one embodiment, the torso 316 contains a simulated heart, lungs, andribs. The heart (not depicted) beats by the action of a pulsatile flowwhich is controlled by the program 15 a in response to the condition ofthe patient and upon therapeutic interventions. Palpable pulses may befound at carotid, brachial, radial, femoral, and pedis dorsis locations.Specific pulse locations become non-palpable as the systolic pressurefalls, and the absence or presence of a pulse will depend upon thesimulated blood pressure. Heart sounds are heard at appropriatelocations through the use of the stethoscope 12 j. The heart beat issynchronized with the Virtual EKGs, which are determined by the program15 a. Application of the stethoscope 12 j to a point below the BP cuff30 d (FIG. 2) will cause the appropriate Korotkoff sounds to be heard.

The maternal simulator 300 displays a combination of ventilation means,and lung and airway sounds are heard at appropriate locations using thestethoscope 12 j. The simulator 300 breathes spontaneously in a mannerthat would achieve targeted arterial blood gases for a given situation,including response to interventions such as ventilation andadministration of drugs, and demonstrates the amount of chest riserelating to the tidal volume and physiologic states. Normal gas exchangelung dynamics are virtual and are controlled by the program 15 a, whichmay also determine tidal volumes (TV), functional residual capacity(FRC), and expired carbon dioxide (CO₂). Airway resistance, lung andchest wall compliance are also controlled by the program 15 a.

The heart and lungs are connected to pressure transducers confirmingairway ventilation and cardiac compression. For example, an air line maybe mounted in tracheal wall or lungs of the simulator 300 and connectedto a sensor circuit connected to the CIM 16 so that when cardiopulmonaryresuscitation (CPR) ventilation is performed on the simulator, the CIM16 monitors the timing and magnitude of the pressure and volume of theventilation procedure, via the air line and the sensor. Similarly, acompression bladder may be embedded within the heart or chest cavity ofthe simulator 300 for sensing and confirming proper timing and magnitudeof a CPR chest compression procedure, when connected by an air line to acompression sensor circuit attached to the CIM 16. It can be appreciatedthat compression and ventilation data is acquired from pressure wavessensed by the CIM 16 through the lines 36. The blood pressure, heartrate, and oxygen saturation is virtually measured by the BP cuff 30 d(FIG. 2) and the Pulse Ox cuff 30 e (FIG. 2), although the datadisplayed is generated by the program 15 a.

Referring to FIG. 10, a neonate simulator 302′ may be used to replacethe fetal simulator 302 (FIG. 8) to allow practice of neonatalresuscitation according to the program 15 a. In other embodiments, thefetal simulator 302 is itself used in post-birth simulations. In thatregard, the fetal simulator 302 can have all of the functionalities andfeatures of the neonate simulator 302′ as described herein. The neonate302′ has a head 370, with hair 372, eyes 374 a-b, a nose 376, and amouth 378. The head assembly contains a realistic airway (not depicted)capable of accepting conventional airway adjuncts and a sensor fordetermining whether an airway adjunct has been placed, or whether afluid has passed. The head 370 is connected via a neck 380 to a torso382.

Sensors, generally denoted 30 (FIG. 1 a), may be disposed on the skin ofthe neonate simulator (shown as stippled) and/or beneath the skin (shownin phantom). Lines 36″ protrude from the torso 382 for providingelectrical, pneumatic, or fluid connection, as well as for connectingsensors (not depicted) to the CIM 16. The torso 382 has an umbilicalsite 384, which provides a site for catheterization, and a simulatedheart, lungs, and ribs for performing CPR. The heart and lungs areconnected to pressure transducers as described above for the maternalsimulator 300 for confirming airway ventilation and cardiac compression.The neonate simulator 302′ exhibits many of the same features as thematernal simulator 300 (FIG. 6), including heart rate, pulse,oxygenation, and a variety of body sounds which can be detected usingthe stethoscope 12 j (FIG. 2) or a conventional stethoscope. A pair ofarms 386 a-b, and a pair of legs 388 a-b, are also connected to thetorso 3382.

In one embodiment, the hands and feet as well as the face and uppertorso change color based upon proper oxygenation or an oxygen deficit.As oxygenation decreases, the extremities (peripheral cyanosis) changecolor first, followed by the face and upper torso (central cyanosis).Such change is reversible as oxygenation is improved.

In a preferred embodiment, coloration is achieved using bluethermochromatic dye (such as Reversatherm Blue Type F, available fromKeystone, Chicago, Ill.), approximately 3 grams dissolved in 10 grams ofclear vinyl paint thinner, and dispersed into 300 grams of clear vinylpaint. The mixture is applied to the hands, feet, chest, and face. Atroom temperature, the neonate is blue. Resistance heaters (such asavailable from Minco Products, Minneapolis, Minn.) are connected inparallel, and placed under the skin to provide 5-15 watts/in², or heatenergy sufficient to raise the surface temperature of the skin to about115°, causing the bluish color to disappear. Power for the heater issupplied through the CIM 16. The peripheral and central heaters may beseparately controlled to allow peripheral cyanosis without centralcyanosis. Heat sinks may also be disposed with the heaters to allowfaster cooling, and hence, faster changes in coloration.

In one embodiment, the thermochromatic system is logically linked to theprogram 15 a, for example, an instructor defines the condition of theneonate. Afterwards, coloration is responsive to CPR quality beingperformed by a user, improving, worsening, or remaining the same. Theprogram 15 a also provides for an override if coloration changes are notdesired. Coloration may alternatively be simulated by having applied aconventional photochrome to the simulator, such that upon exposure to anassociated adjustable UV light, the simulator appears to turn blue. Asanother alternative, the coloration may be simulated by using coloredlights. For example, in one aspect blue LEDs can be used.

As mentioned above with respect to the maternal simulator, in someembodiments the neonatal simulator does not include lines 36″. Ratherthe neonatal simulator is tetherless such that is has self-containedfunctionality without the need for wired, tubed, or other physicalconnection to external devices.

Referring now to FIG. 11, a child birthing system 500 illustrates theuse of the foregoing embodiments. The simulator 14, for example, thematernal simulator 300 and fetus 302 are placed on a table 502.Students, W, X, Y, and Z, take places around the table, for example, Wcontrols medication, Y controls virtual instruments 12, X controlsanesthesia, and Z controls obstetrics. The child birthing device 326, asdiscussed above, may be driven via a manual crank or by a small motor326 a connected to either a control box 328, or the program 15 a of thecomputer 15 may optionally (shown in phantom) control the birthingdevice 326. Whichever controlling means are used, the distensible cervixaccurately reflects progress of the fetal simulator down the birthcanal. Eventually, as described above, the fetal simulator is birthed.

Once the fetal simulator is birthed, a team W′, X′, and Y′ (which areunderstood to be the same students W, X, and Y, or others depending onclass size) moves along path 1 to practice neonatal care on a table502′. At least one team, denoted by the absence of Z, must remain behindwith the maternal simulator for monitoring and potential stabilization.The fetal simulator is switched with a neonatal simulator 14′, forexample, neonatal simulator 302′ (FIG. 10). If connected to thecomputer, the program 15 a may be used to simulate the need for neonatalresuscitation, and CPR and other emergency care protocols may beperformed. The program 15 a monitors the care received by the simulatorvia the CIM 16 and virtual instruments 12, and compares the care toaccepted standards.

Meanwhile, the program 15 a of the computer 15 may be used to simulatethe need for maternal resuscitation. If so, a team moves along path 2 topractice maternal care on a table 502″. Students, W″, X″, Y″, and Z canwork on the maternal simulator 14″, for example maternal simulator 300with the fetal simulator removed. CPR and other emergency care may begiven, and the program 15 a monitors the care received by the simulatorvia the CIM 16 and virtual instruments 12.

Referring now to FIG. 12, an introductory screen display 400 of theprogram 15 a is presented on the computer 15 for teaching patient careprotocols to a user. The display 400 includes several decorativefeatures: a title box 402, a fetal heart rate box 404, a maternalintrauterine pressure box 405, a vital signs box 406, and an ultrasoundvideo box 407. The display 400 also contains a teaching box 408, atesting box 410, and a virtual instruments box 412. As will bedescribed, in some modules, the program 15 a compares informationpertaining to the user's activity with predetermined standards.

The screen 400 also displays a group of selectable patient care modules414 a-p provided by the program 15 a, which furnish information onmedical topics and associated concepts. Each module has a single topic,and represents an interactive patient care training session for theuser. The modules 414 a-g are disposed in the teaching box 408, and givean overview of relevant physiology, pregnancy, complications, labor andbirth, postpartum, and maternal and neonatal resuscitation protocols.The modules 414 h-j are disposed in the testing box 410, and give anopportunity to test a user in maternal and neonatal resuscitationprotocols, as well as instructor defined protocols (Codemaker). An exitbutton 415 for exiting the program 15 a is also disposed in the testingbox 410. The modules 414 k-p are disposed in the virtual instrumentstutor box 412, and give a user a tutorial on use of the system,including automatic birthing, fetal ultrasound, fetal distress monitor,vital signs, Partographs, and heart and lung sounds.

Referring to FIG. 13, if one of the modules (FIG. 12) is selected by theuser, such as by voice recognition or selection with a mouse of thecomputer 15, the program 15 a displays a display screen 416. The displayscreen 416 contains an information box 418, which contains topicalinformation. The display screen 416 also has a menu bar 420 containinginformation items (illustrated as A-D for convenience) listinginformation categories specific to the topic of the selected module. Itis understood that an item may be selected from the screen 416 via themenu bar 420, and that each module 414 a-p has its own display screenwith its own menu of specific informational items A-D, which may beexpanded to include a large number of items, or condensed for example,by placing selectable sub-items under an item.

Selection of an item from a menu, other than an exit item, causes textand/or illustrations topical to the selected menu item to be displayedin the information box 418. In practice, the program may generate a newdisplay screen (not depicted). As such, it is understood that theinformation screen 416 is used as an example of any number of screens,and furthermore, such screens can be displayed in sequential order, or aseries, for each item. A series of screens, such as screen 416,comprises a tutorial regarding patient treatment protocols for theselected menu item. Thus, the user can review information from a libraryof topics by selecting the appropriate module, and item, and thennavigating through a series. Navigation in a series of screens isattained by the user's selection between three boxes: 422, 424, and 426,respectively “Back”, “Next”, and “Exit”, with corresponding functionamong the screens, such as proceeding backwards or forwards in theseries. If no “Back” or “Next” function is possible, as respectivelywould be the case of the first and last screen of a series, the boxes422 or 424 may be unselectable.

For example, modules 414 f and 414 g each engender a series to teach auser about maternal and neonatal resuscitation, respectively. The usermay also practice CPR on the simulator 14 (FIG. 1 a), such as thematernal simulator 300, or the neonatal simulator 302′, above, and theprogram 15 a senses the user's compression and ventilation, via the CIM16 (FIG. 1 a) and sensors 30 (FIG. 1 a). The heart and lungs of thesimulator 14 are connected to pressure transducers confirming airwayventilation and cardiac compression; for example, an air line may bemounted in tracheal wall of the simulator 14 and connected to a sensor30 connected to the CIM 16, so that when CPR ventilation is performed onthe simulator, the CIM 16 monitors the timing and magnitude of thepressure and volume of the ventilation activity, via the air line andthe sensor. Similarly, a compression bladder may be embedded within thechest cavity of the simulator 14 for sensing and confirming propertiming and magnitude of a CPR chest compression procedure, whenconnected by an air line to a compression sensor 30 attached to the CIM16. The program 15 a compares the information pertaining to the user'sactivity with predetermined standards, and thus provides an interactivetraining session.

The predetermined standards are selectable, and reflect medicalprotocols used around the world, including BLS and ACLS guidelines setforth by the American Heart Association and others. At least seven majorprotocols for cardiopulmonary resuscitation (CPR) are stored andselectable by the user. Moreover, a user may update the protocols, orenter and store a “New Protocol” reflecting the local protocol regardingdepth, duration, and frequency of cardiac compressions and airwayventilations. The program will use this series of acceptable limits togenerate a new CPR waveform for testing CPR.

Referring back to FIG. 12, selection of a test module 414 h-j from thetest box 410 directs execution of the program 15 a to provide a testingsequence to help test the user on patient care protocols, such asmaternal and neonatal resuscitation, and other responses to emergencyscenarios. The program 15 a paces through the steps of a patientdistress scenario, giving the user a predetermined time to respond orcomplete the task required, thus enabling the user to experience thepressure of an emergency situation. For example, the program 15 a maytest the user by presenting choices from which the user must select inorder to treat the patient, wherein the user must complete the correctchoice before the sequence proceeds to the next event. The program 15 aenables the user to enable, disable, or check the virtual instruments 12and sensors 30 for connection to supply input to the CIM 16.

If the virtual instruments 12 (FIG. 2) are enabled, the user mayimplement patient care activity on the simulator 14 using the virtualinstruments 12, while having the results and quality of response beingmonitored by the program 15 a. Alternatively, the user may usesoftware-simulated instruments 12′ (FIG. 1 b) generated by the program15 a. The program 15 a advances through the scenario until the patientrecovers, and provides a running critique of the user's responses, withan explanation of each incorrect choice or action. Features of the testmodules 414 h-j include items that enable the user to specify thataction sequences prescribed by the scenario comprise a predeterminednumber of compression/ventilation cycles on the simulator 14, or toallow the user to record the time and magnitude of the compression andventilation activity performed on the simulator 14, or to select among agroup of choices for hearing realistic sounds.

Testing may be defined by the program 15 a, as above, or by the user.For example, selection of the Codemaker Test module 414 j (FIG. 12)allows a first user, for example, an instructor, to create a scenario totest a second user, for example, a student. The first user may inputpreliminary data to define the patient simulator of the testing scenarioby entering a set of preliminary patient parameters regardinginformation such as sex, weight, and age, as well as patientindications, vital signs and cardiac rhythms which will be realisticallyreflected in the vital signs monitor 406 (FIG. 12). An instructordefined testing system allows the instructor to test the student onlocal, national, or international patient care protocols. Manyalgorithms are selectable by opening files, including BLS, ACLS,Pediatric, and Obstetric (OB) emergencies. Other algorithms may becreated and stored, and algorithms may be linked together as well.Benefits of this module include flexibility for instruction and theability to detect mastery of the subject. An instructor-definedalgorithm would presumably vary from well-known, structured algorithms,and thus avoid the problem of rote memorization of responses by thestudent.

Action may be taken in response to the conditions by the student, forexample, the student may select among virtual instruments to use torender patient care activities. The student may then perform the patientcare activities virtually, or using the tangible simulator.

Use of the modules 414 k-p of the virtual instruments tutor box 52provides information about instruments commonly used in child birthingscenarios. In some instances, opportunities to practice using some ofthe virtual instruments 12 in patient care protocols with the simulator14 are provided.

Turning now to FIGS. 14 and 15, the entire child birthing process may beautomated via the program 15 a, with the user merely defining initialconditions, such as delivery time 430, delivery profile 432, andcontraction intensity 434. The warp feature allows a full delivery to becondensed from 16 hours to 5 minutes. Child birthing then consists ofplacing the fetal simulator 302 on the projection 344, and placing thecover 324 on the maternal simulator 300. The program 15 a also offers avarying rate for progress of the ram 346, i.e., the first fewcentimeters may proceed much more slowly than the last few centimetersto better simulate child birth.

Referring to FIG. 16, if module 414 m (FIG. 12) is selected, a series ofscreens are shown regarding the fetal distress monitor, with tutorialinformation. An exemplary fetal distress monitor box 436 is depicted,along with a selectable On button 436 a for turning on the monitor. Thefetal distress monitor 12 l cooperates with the simulator 14, the fetalheart monitor is placed on the cover 324 of the maternal simulator 300(FIG. 5 a) and interacts with at least one sensor 30, while thecontractions monitor interacts with another sensor 30 disposed on thecover.

Referring to FIG. 17, a neonate simulator 600 may be used to replace thefetal simulator 302 to allow practice of neonatal resuscitationaccording to the program 15 a. In one embodiment, the neonate simulatoris substantially the size of an average sized neonate of 28 weeksgestational age. In another embodiment, the neonate simulator 600 issubstantially the size of an average sized neonate of 40 weeksgestational age. The neonate simulator 600 exhibits many of the samefeatures as the maternal simulator 300, including heart rate, pulse,oxygenation, and a variety of body sounds that can be detected using thevirtual stethoscope 12 j or a conventional stethoscope. Further, asdescribed below the neonate simulator 600 is self-sufficient in that itdoes not require wired or tubed connection to any external devices forproper operation its numerous features, such as bulky externalcompressors and power supplies. The neonate simulator 600 is portable.In some embodiments the neonatal simulator is tetherless, such that itis functional without wired, tubed, or other physical connection toother external devices.

The neonate simulator 600 has a head 602, with hair 604, eyes 606 and608, a nose 610, and a mouth 612. The head 602 is connected via a neck614 to a torso 616. The torso 616 includes an umbilical site 618 thatprovides a site for catheterization. The torso 616 also includes aninterchangeable genitalia site 620 that is adapted to receive both maleand female genitalia pieces (not shown). Two arms 622 and 624 areconnected to and extend from the upper portion of the torso 616. Twolegs 626 and 628 are connected to and extend from the lower portion ofthe torso 616.

Sensors, generally denoted 30, may be disposed on the skin of theneonate simulator 600 (shown as stippled) and/or beneath the skin (shownin phantom) to provide various simulated features, as previouslydescribed. The torso 616 contains a simulated heart, lungs, and ribs forperforming CPR. In one aspect, the heart and lungs are connected topressure transducers as described above for the maternal simulator 300for confirming airway ventilation and cardiac compression. The torso 616also contains other components such as the power supply and wirelesscommunication devices. In one embodiment, the power supply is arechargeable pack of five lithium-ion cells. In one aspect, the powersupply is positioned in the area normally reserved for the liver.

To fit all of the functionality of the neonatal simulator 600 into amanikin the size of a neonate of 28 or 40 weeks gestational age, thenumerous electronics must be appropriately sized and preciselypositioned within the manikin where they are needed. In one embodiment,the electronic components of the neonate simulator 600 are grouped intosmaller modules based on function, rather than placed on a generalmotherboard. For example, FIG. 18 illustrates one possible set ofmodules 630 for use in the neonate simulator 600. The set of modules 630includes a master module 632 for interfacing the neonate 600 with thecomputer; a module 634 for generating the ECG signal; a module 636 forgenerating sounds such as heart, lungs, voice, and Korotkoff sounds; amodule 638 for sensing pressure such as chest compression, airwayventilation, blood pressure, and compressor pressure; a module 640 formonitoring intubation; a module 642 for driving valves and LEDs; amodule 644 for providing a connection such as a wireless interface andUSB-RF interface; a module 646 for producing voice sounds; and a module648 for producing sounds other than voice. One or more of these modules632-648 can be combined to create any number of simulation features forthe neonate simulator 600.

Referring to FIG. 19, the neonate simulator 600 includes a realisticairway 650 accessible via the mouth 612 and nose 610. The airway 650 iscapable of accepting conventional airway adjuncts and a sensor, such asmodule 640, is positioned adjacent the airway for determining whether anairway adjunct has been placed, or whether a fluid has passed throughthe airway. In one embodiment, the module 640 is an optical sensor thatmonitors the position of an airway adjunct, such as an endotrachialtube, and determines the adjunct is positioned too high, too low, orjust right. The neonate simulator 600 also includes a simulatedesophagus 652 that extends into the torso 616 to a simulated stomach.

Referring to FIG. 20, the neonate simulator 600 also includes an airsupply system 654 to simulate breathing, pulse, and associatedphysiological conditions of the neonate. The air supply system 654includes a muffler 656, a compressor 658 (that may be a single diaphragmcompressor such as model T2-03-E, available from T-Squared Pumps of NewJersey), a check valve 660 (appropriate valves may be obtained from GulfControls of Florida), a compressor controller 662, a primary accumulator664, and a secondary accumulator 666. The compressor can alternativelybe a rotary compressor or other suitable compressor.

In operation, the air supply system 654 provides pressured air to theneonate simulator 600 as follows. Air from the atmosphere 668 or areservoir enters the compressor through the input muffler 656. Thecompressor controller 662 is utilized to maintain the pressure in theprimary accumulator 664. A check valve 660 ensures air flow is in theproper direction. A pressure regulator (not shown) can be used tomaintain a predefined pressure in the secondary accumulator. The primaryand secondary accumulators are connected to actuators of the neonatesimulator 600 for controlling supply of air. In one embodiment, theprimary accumulator is connected to an actuator for controlling thesupply of air to airway 650. In one embodiment, the secondaryaccumulator is connected to an actuator for controlling the supply ofair to the lungs. The compressor controller 662 selectively providespower to the compressor 658 to maintain the desired pressure in theprimary accumulator 664. In one embodiment, the approximate desiredpressure of the primary accumulator is between 4.5-5.5 psi and theapproximate desired pressure of the secondary accumulator is 1.5 psi. Insome embodiments the air supply system 654 is further connected to thesimulated circulatory system to provide simulated pulses or otherwisefacilitate the simulated circulatory system.

The components of the air supply system 654 are positioned, insulated,and muffled to minimize the noise produced by the system. Since userswill be utilizing stethoscopes to assess heart and breathing sounds ofthe neonate simulator 600, excessive noise from the air supply system654 can interfere with and distract the user. To this end, portions ofthe air supply system 654 may be stored in the head 602 and extremities(arms 622, 624 and legs 626, 628) of the neonatal simulator 600.

For example, in one embodiment the compressor 658, the check valve 660,and the compressor controller 662 are positioned in the head 602 and themufflers and accumulators are positioned in the legs 626, 628. The noisecreated by the components in the head is shielded by a sound dampeningenclosure 672, illustrated schematically in FIG. 20. In one embodiment,the sound dampening enclosure 672 is a bilayer system having a firstlayer serving as an acoustic barrier and a second layer serving as amass barrier. In one aspect, the acoustic barrier and the mass barrierare formed of noise abatement materials from EAR Specialty Composites.Further, the exhaust air created by the compressor 658 is ported downinto legs 626, 628 of the simulator 600. Each leg 626, 628 includes amuffler system and an air reservoir. The muffler system dampens the“noisy” exhaust air to provide the air reservoir with a supply of“quiet” air for use by the neonate simulator 600 for the breathing andpulse simulations. In one aspect, the legs 626, 628 themselves serve asthe air reservoirs and are sealed to prevent leakage.

FIG. 21 shows an exemplary embodiment of a muffler system 674. Themuffler system 674 has three separate portions 676, 678, and 680 thatdampen the sound from the noisy air. Each portion 676, 678, 680 has afirst layer 682, 682, and 686, respectively, that serves as an acousticbarrier and a second layer 688, 690, and 692, respectively, that servesas a mass barrier. In one aspect, the acoustic barrier and the massbarrier are formed of the same noise abatement materials from EARSpecialty Composites as the sound dampening enclosure 672 describedabove. The noisy air is ported into the muffler system through a tube694. The quiet or dampened air then exits the muffler through a tube696. In one embodiment, the each leg 626, 628 is lined with noiseabatement material in addition to the muffler system to further muffleand dampen any noise.

In one embodiment the hands and feet as well as the face and upper torsochange color based upon proper oxygenation or an oxygen deficit. Asoxygenation decreases, the extremities (peripheral cyanosis) changecolor first, followed by the face and upper torso (central cyanosis).Such change is reversible as oxygenation is improved. In one embodiment,the amount of time the neonate is without oxygen determines where thecolor and corresponding vital signs start, and the effort that isrequired to successfully bring the neonate back to healthy condition. Insome embodiments, the simulator includes a mechanism for independentlychanging the color of the central portion and the peripheral portions.The mechanism, in some embodiments, utilizes blue LEDs or other lightingto simulate cyanosis.

In one embodiment, the thermochromatic system is logically linked to theprogram 15 a, for example, an instructor defines the condition of theneonate. Afterwards, coloration is responsive to CPR quality beingperformed by a user, improving, worsening, or remaining the same. Forcomparison, an adult can tolerate between 5-10 minutes without oxygen. Apregnant mother or the maternal simulator 300 uses oxygen more quicklythan a normal adult and, therefore, is affected more quickly. A neonate,on the other hand, can tolerate on the order of 15 minutes withoutoxygen, with death in about 30 minutes. Thus, if the hypoxic event is5-7 minutes the neonatal simulator 600 will “pink up” rather easily. Ifthe hypoxic event is 12-15 minutes then recovery will be slower andrequires more effort on the part of the user. Further, if the hypoxicevent is more than 20 minutes, then it is very difficult even with theuse of epinephrine for the user to get the neonatal simulator 600 to“pink up,” and the neonatal simulator 600 can die or suffer somelifelong malady, such as cerebral palsy.

In one embodiment, the instructor can select the degree of cyanosis ofthe neonatal simulator 600, as shown in the screen display 700 of FIG.22. Though not shown in the screen display 700, the instructor may alsoselect or define various other attributes of the neonatal simulator 600,such as the muscle tone in the arms 622, 624 and the legs 626, 628(e.g., limp, well-flexed, motion, etc.) and the “speech” of the neonatalsimulator 600 (e.g., crying, grunting, stridor, etc.). The vital signsand recovery of the neonatal simulator 600 can be monitored using adisplay 702, as shown in FIG. 23. The program also provides for anoverride if coloration changes are not desired.

Referring now to FIGS. 24-27, shown therein is an engagement system 740that is an alternative embodiment to the receiver 342 and projection 344system for selectively engaging the fetal or neonatal simulator 302, 600to the maternal simulator 300. The engagement system 740 includes amechanism 742 that engages a mechanism 744. In some embodiments, themechanism 742 is disposed within the fetal or neonatal simulator 302,600 and the mechanism 744 is disposed within the maternal simulator 300.In one embodiment, the mechanism 742 is adapted to replace the receiver342 and the mechanism 744 is adapted to replace the projection 744. Inother embodiments, the mechanism 742 is disposed within the maternalsimulator 300 and the mechanism 744 is disposed within the fetal orneonatal simulator 302, 600.

Referring more specifically to FIG. 25, the mechanism 742 includes ahousing 745 with an opening 746 extending therethrough. In the currentembodiment the opening 746 is centrally located and substantiallycylindrical. In other embodiments, the opening 746 can have variousother cross-sectional shapes, including polygon, irregular, and othershapes. The mechanism 742 also includes a locking portion 748. Thelocking portion 748 and housing 745 can be permanently secured together(e.g. glued) or temporarily secured together (e.g. threaded engagement).Further, the locking portion 748 and/or the housing 745 may includeadditional features not shown to facilitate the engagement between thetwo pieces. In other embodiments the housing 745 and the locking portion748 are an integral piece.

As shown in FIG. 26, the locking portion 748 includes a body portion749. The body portion 749 is adapted to mate with the opening 746 of themechanism 742. Thus, in the current embodiment the body portion 749 issubstantially cylindrical, but in other embodiments may have othercross-sectional shapes to match opening 746. The locking portion 748further includes an actuator 750 for moving locking pins 752 from anextended position, shown in FIG. 26, to a retracted position. In oneembodiment the retracted position of the locking pins 752 issubstantially within the body portion 749 of the locking portion. Asdescribed below, the selective extension and retraction of the lockingpins 752 cause selective engagement of the mechanism 742 with themechanism 744. In this manner the fetal and neonatal simulators 302, 600are selectively engaged with the maternal simulator 300. In someembodiments, the actuator 750 is selective actuated by a solenoid. Insome embodiments, the solenoid is disposed within the fetal or neonatalsimulator 302, 600 or maternal simulator 300 adjacent the actuator 150.In some embodiments, the solenoid is located within the mechanism 742.In some embodiments, the solenoid is actuated via wireless device or acomputer system such that an instructor can selectively release thefetal or neonatal simulator.

Referring more specifically to FIG. 27, the mechanism 744 includes abody portion 754. In the current embodiment, the body portion 753 issubstantially cylindrical, but in other embodiments has othercross-sectional shapes. The mechanism 744 also includes an engagementportion 754. The engagement portion 754 has a substantially squarecross-sectional shape, but in other embodiments has othercross-sectional shapes. The engagement portion 754 further includes anopening 755 extending therethrough. The opening 755 is adapted toreceive the locking portion 748 of the mechanism 742. The engagementportion 754 also includes locking openings 756. The locking pins 752 ofthe locking portion 748 are adapted to engage openings 756 whenextended. When retracted, the locking pins 752 retract from the openings756 releasing locking mechanism 748 from the engagement portion 754.

Referring to FIG. 28, shown therein is a system for providing selectiverotation to the fetal or neonatal simulators 302, 600. The system isadapted to move the cam 348 a between a first position for causingrotation of the fetal simulator and a second position that does notcause rotation of the fetal simulator. In this manner the system can beused to selectively rotate or not rotate the fetal simulator during abirthing simulation. In some embodiments, retracting the cam 348 a to aposition adjacent the track 347 a prevents rotation of the fetalsimulator. In some embodiments, the cam 348 a is further moveable to anintermediate position that causes some rotation of the fetal simulator,but less rotation than the first position. In some embodiments, the cam348 a is moveable between a plurality of intermediate positions eachallowing a different amount of rotational movement. In some embodiments,the plurality of intermediate positions and the amount of rotation arecontinuous. In other embodiments, the plurality of intermediatepositions and the amount of rotation are discrete.

The system includes a solenoid 760 that is adapted to selectivelyretract the cam 348 a. The solenoid 760 is a connected to the cam 348 avia an extension 761 and a fixation member 762. In one embodiment, thefixation member 762 is a bolt, screw, other threaded member, or otherdevice for connecting the cam 348 a to the extension 761. The cam 348 ais connected to track 347 a via fixation members 764 and 766. Thefixation members 764 and 766 in some embodiments are bolts and nuts. Thefixation members 764 and 766 also serve to prevent unwantedtranslational and rotational movement of the cam 348 a with respect totrack 347 a. In other embodiments, the cam 348 a and solenoid 760 may beadapted to translate along the track 347 a. Further, in some embodimentsthe cam 348 a may be adapted for rotational movement with respect totrack 347 a. In some embodiments, the position of the cam 348 a iscontrolled remotely, and in some embodiments wirelessly, by theinstructor or computer program. Though the system has been describedwith respect to track 347 a and cam 348 a, the same system is applied totrack 347 b and 348 b.

FIG. 29 is a diagrammatic schematic view of a patient simulator system1100 according to one embodiment of the present disclosure. The patientsimulator system 1100 includes a patient simulator 1102 and a controlsystem 1104. The patient simulator 1102 includes a plurality of modulesfor performing the various functions of the simulator. In someembodiments, each of the modules controls a particular function or groupof functions of the simulator 1102. In that regard, the modules areappropriately sized for positioning within various portions of thesimulator 1102. In some embodiments, the modules are positionedthroughout the simulator adjacent to the region or area of the simulator1102 related to the module's specific function or the associated bodypart of the simulator. Accordingly, the modules are distributedthroughout the simulator rather than being grouped onto a singlemotherboard. In some embodiments, each of the modules is incommunication with a master module 1106. As will be described in greaterdetail with respect to FIG. 32 below, in some embodiments the mastermodule 1106 is configured to provide and control the power delivered tothe modules and facilitate communication with and among the modules.

In the current embodiment, the patient simulator 1102 is in wirelesscommunication with the control system 1104. In that regard, the patientsimulator 1102 includes a wireless communication module 1108 and anantenna 1110. The wireless communication module 1108 and antenna 1110are in communication with an antenna 1112 and a wireless communicationmodule 1114 of the control system 1104. In the current embodiment thewireless communication module 1114 is connected to or in communicationwith a computer system 1116. In that regard, the computer system 1116 isa laptop or tablet PC in some instances. Generally, the computer system1116, or the control system 1104 as a whole, is any combination ofhardware and software capable of controlling or defining various factorsand/or functions of the patient simulator 1102.

In that regard, the computer system 1116 or the control system 1104comprises one or more of a microprocessor, an input device, a storagedevice, a video controller, a system memory, a display, and acommunication device all interconnected by one or more buses. Thestorage device could be a floppy drive, hard drive, CD-ROM, opticaldrive, or any other form of storage device. In addition, the storagedevice may be capable of receiving a floppy disk, CD-ROM, DVD-ROM, orany other form of computer-readable medium that may containcomputer-executable instructions. Further communication device could bea modem, network card, or any other device to enable the system tocommunicate with other devices including the simulator 1102. It isunderstood that any system could represent a plurality of interconnected(whether by intranet or Internet) computer systems, including withoutlimitation, personal computers, mainframes, PDAs, and cell phones.

A computer system typically includes at least hardware capable ofexecuting machine readable instructions, as well as the software forexecuting acts (typically machine-readable instructions) that produce adesired result. In addition, a computer system may include hybrids ofhardware and software, as well as computer sub-systems. Hardwaregenerally includes at least processor-capable platforms, such asclient-machines (also known as personal computers or servers), andhand-held processing devices (such as smart phones, personal digitalassistants (PDAs), or personal computing devices (PCDs), for example).Further, hardware may include any physical device that is capable ofstoring machine-readable instructions, such as memory or other datastorage devices. Other forms of hardware include hardware sub-systems,including transfer devices such as modems, modem cards, ports, and portcards, for example.

Software includes any machine code stored in any memory medium, such asRAM or ROM, and machine code stored on other devices (such as floppydisks, flash memory, or a CD ROM, for example). Software may includesource or object code, for example. In addition, software encompassesany set of instructions capable of being executed in a client machine orserver. Combinations of software and hardware could also be used forproviding enhanced functionality and performance for certain embodimentsof the present disclosure. One example is to directly manufacturesoftware functions into a silicon chip. Accordingly, it should beunderstood that combinations of hardware and software are also includedwithin the definition of a computer system and are thus envisioned bythe present disclosure as possible equivalent structures and equivalentmethods.

Computer-readable mediums include passive data storage, such as a randomaccess memory (RAM) as well as semi-permanent data storage such as acompact disk read only memory (CD-ROM). In addition, an embodiment ofthe present disclosure may be embodied in the RAM of a computer totransform a standard computer into a new specific computing machine.Data structures are defined organizations of data that may enable anembodiment of the present disclosure. For example, a data structure mayprovide an organization of data, or an organization of executable code.Data signals could be carried across transmission mediums and store andtransport various data structures, and, thus, may be used to transportinformation in some embodiments of the present disclosure.

The system may be designed to work on any specific architecture. Forexample, the system may be executed on a single computer, local areanetworks, client-server networks, wide area networks, internets,hand-held and other portable and wireless devices and networks. Adatabase may be any standard or proprietary database software, such asOracle, Microsoft Access, SyBase, or DBase II, for example. The databasemay have fields, records, data, and other database elements that may beassociated through database specific software. Additionally, data may bemapped. Mapping is the process of associating one data entry withanother data entry. For example, the data contained in the location of acharacter file can be mapped to a field in a second table. The physicallocation of the database is not limiting, and the database may bedistributed. For example, the database may exist remotely from theserver, and run on a separate platform. Further, the database may beaccessible across the Internet. Note that more than one database may beimplemented.

The wireless communication between communication modules 1108 and 1114is performed using any wireless protocol capable of transferring databetween the patient simulator 1102 and the control system 1104. In oneparticular embodiment, the wireless protocol between the communicationmodules 1108 and 1114 utilizes the 802.15 protocol. In otherembodiments, the wireless communication utilizes other communicationprotocols including, but not limited to other IEEE 802 protocols andtelecommunication network protocols.

The patient simulator 1102 includes a power supply 1118. In the presentembodiment, the power supply 1118 is a rechargeable battery. In thatregard, the power supply 1118 is connected to a charger 1120. Thecharger 1120 is configured to recharge the power supply 1118. In thatregard, the charger 1120 is configured for communication with anexternal power supply 1122. In the current embodiment, the externalpower supply 1122 is a wall outlet or standard line power supply. Inother embodiments, the external power supply 1122 is configured forwireless communication with the charger 1120 or power supply 1118 suchthat the power supply 1118 may be recharged wirelessly, such as byinductive coupling or other wireless charging means. In someembodiments, the charger 1120 comprises a backup power supply.

As mentioned above, the patient simulator 1102 includes a plurality ofmodules for controlling the various features and functions of thesimulator. In that regard, various modules may be combined to create asimulator with specific features as desired by a customer or user. Inthis manner, the modules included in the patient simulator 1102 may beselected based on the intended use of the simulator. The modular natureof the function-specific modules allows the simulator 1102 to includethose features that a customer desires initially in any combination, butalso allows a customer to add additional features or disable includedfeatures later. One specific combination of available modules for use inthe simulator 1102 will now be described with respect to FIG. 29.However, no limitation is intended thereby. In that regard, it isunderstood that the patient simulator 1102 may include additional,fewer, or other combinations of modules in other embodiments. Variouscombinations of the modules illustrated in FIG. 29 are particularlysuited for use in different types of patient simulators. For example, insome instances combinations of modules are selected for use in amaternal simulator for simulating a birthing sequence including thebirthing of a fetal simulator. In other embodiments, combinations ofmodules are selected for use in patient simulators of various sizes andages from neonatal to full grown adult and therebetween. Accordingly, apatient simulator system according to the present disclosure may includesome or all of the modules illustrated in FIG. 29.

The patient simulator 1102 includes a voice module 1124. The voicemodule 1124 is in communication with the master module 1106, which is incommunication with the control system 1104. The voice module 1124 is anaudio module configured to emit sounds simulating a patient's voice. Inthat regard, the particular sounds emitted by the voice module 1124 arecontrolled in some embodiments by a user through the control system1104. In some embodiments, the control system 1104 includes a pluralityof stored or prerecorded sounds that may be selected from and playedback by the voice module 1124.

In some embodiments, the sounds include one or more of various answersto questions medical personnel might ask a patient and/or sounds apatient might make. For example, the answers may include variouscomplaints (e.g., “ankle broken”, “arm broken”, “blood in toilet”,“can't catch breath”, “can't move”, “can't move legs”, “chest hurts”,“coughing up blood”, “elephant on chest”, “feel dizzy”, “feel nauseous”,“feel weak”, “heart beating fast”, “heart pounding”, “heart trying tojump”, “hurt all over”, “hurts when breathing”, “I′ ve been cut”, “jawhurts”, “left arm hurts”, “leg is broken”, “passing blood”, “peeingblood”, “pooping blood”, “puking blood”, “short of breath”, “shoulderhurts”, “somebody shot me”, “stomach hurts”, “worst headache”, and/orother complaints), confused answers (e.g., “Are you a doctor?”, “I don'tremember”, “What happened?”, “Who are you?”, and/or other confusedanswers), location answers (e.g., “in my arm”, “in my chest”, “in myleg”, “in my shoulder”, “left side”, “right side”, and/or other locationanswers), descriptive answers (e.g., “a little bit”, “a lot”, “I can'tmove it”, “it's dull”, “it's sharp”, “not pain . . . pressure”, “pain incenter chest”, “sharp tearing pain”, and/or other descriptive answers),evasive answers (e.g., “I feel fine”, “take me to a hospital”, and/orother evasive answers), generic answers (e.g., “yes”, “no”, “maybe”,and/or other generic answers), history answers (e.g., “asthma”,“diabetes”, “emphysema”, “had heart attack”, “high blood pressure”,and/or other history answers), occurrence answers (e.g., “once”,“twice”, “three times”, “four times”, “since last night”, “since thismorning”, “since this afternoon”, and/or other occurrence answers). Inaddition to the answers and responses noted above, the sounds includecoughing, gagging, choking, moaning, screaming, and/or other sounds apatient makes. In that regard, each of the sounds may have differentlevels or types. For example, in some instances the sounds includedifferent severity of coughs, gags, moaning, screaming, and/or othersounds.

In some embodiments, the control system 1104 is in communication withthe voice module 1124 such that a user or teacher speaks into amicrophone or other sound communication device associated with thecontrol system and the teacher's words or sounds are emitted from thevoice module 1124. In some embodiments, the user or teacher's input maybe conditioned using audio amplifiers or sound boards to alter the soundof the voice emitted from the voice module 1124. For example, in someembodiments the input sound is conditioned to simulate a hoarse patient,a patient with a blocked air passage, or other mental or physicalmedical condition of the patient. In that regard, the teacher mayselectively activate various types of audio conditioning based on adesired effect. The voice module 1124 and the corresponding voicesimulation are utilized as part of an overall medical scenariosimulation in some embodiments.

The patient simulator 1102 also includes a heart sound module 1126. Theheart sound module 1126 is an audio module configured to emit sounds tosimulate the natural sounds of a patient's heart. In that regard, thesounds of the heart sound module 1126 include one or more of sounds tosimulate the patient's heart rate and cardiac rhythm (e.g., sinus,atrial tachycardia, multifocal atrial tachycardia, atrial flutter,atrial fibrillation, junctional, idioventricular, ventriculartachycardia (uni.), ventricular tachycardia (multi.), supraventriculartachycardia, ventricular flutter, ventricular fibrillation, agonal,asystole, LBBB, RBBB, 1^(st) degree AVB, 2^(nd) degree AVB (Type I),2^(nd) degree AVB (Type II), 3^(rd) degree AVB, Q-wave infarction, STsegment elevation, ST segment depression, T-wave inversion, atrialpaced, AV sequential paced, vent. Pacemaker (artificial), and/or othercardiac rhythms). Further, the heart sounds may be normal, distant,non-existent, include a systolic murmur, S3, and/or S4. The controlsystem 1104 and/or a user utilizing the control system determines whatheart sounds and at what rate the sounds are produced in someembodiments. The sounds produced by the heart sound module 1126 aredetectable via use of a stethoscope in some instances. In someembodiments, at least a portion of the heart sound module 1126—such as aspeaker—is positioned within the simulator 1102 where the natural heartwould be.

The patient simulator 1102 also includes lung sound modules 1128, 1130,1132, 1134, 1136, 1138, 1140, and 1142. In particular, lung sound module1128 is utilized to simulate sounds of the upper right lung towards thefront of the simulator 1102; lung sound module 1130 is utilized tosimulate sounds of the upper left lung towards the front of thesimulator; lung sound module 1132 is utilized to simulate sounds of thelower right lung towards the front of the simulator 1102; lung soundmodule 1134 is utilized to simulate sounds of the lower left lungtowards the front of the simulator 1102; lung sound module 1136 isutilized to simulate sounds of the upper right lung towards the back ofthe simulator; lung sound module 1138 is utilized to simulate sounds ofthe upper left lung towards the back of the simulator; lung sound module1140 is utilized to simulate sounds of the lower right lung towards theback of the simulator 1102; lung sound module 1142 is utilized tosimulate sounds of the lower left lung towards the front of thesimulator 1102.

Each of the lung sound modules 1128, 1130, 1132, 1134, 1136, 1138, 1140,and 1142 is an audio module configured to produce sounds to simulate thenatural sounds of a patient's lungs. In that regard, the lung soundmodules 1128, 1130, 1132, 1134, 1136, 1138, 1140, and 1142 areconfigured to produce one or more of the following lung sounds in someembodiments: normal, none, wheezing, inspiration squeaks, crackles,rails, and/or other lung sounds. Further, the combination of lung soundmodules 1128, 1130, 1132, 1134, 1136, 1138, 1140, and 1142 are utilizedto simulate respiratory patterns including, but not limited to normal,Kussmaul's, Cheyne-Stokes, Biot's, apneusic, and/or other respiratorypatterns. The combination of lung sound modules 1128, 1130, 1132, 1134,1136, 1138, 1140, and 1142 are also utilized to simulate the respiratoryrate of the patient. In that regard, the respiratory rate may be set ata constant rate and/or be set to change over time.

The patient simulator 1102 also includes a K-sound module 1144 for theright arm of the simulator and a K-sound module 1146 for the left arm ofthe simulator. Each of the K-sound modules 1144 and 1446 are configuredto produce a simulated K-sound (Korotkoff sound). In that regard, theK-sound modules 1144 and 1146 are utilized to allow a user to take theblood pressure of the patient simulator 1102. Accordingly, the K-soundsproduced by the modules 1144 and 1146 are determined based on asimulated heart rate and blood pressure. In some instances, the heartrate and blood pressure of the patient simulator 1102 are provided by auser or teacher via the control system 1104. The patient simulator 1102also includes a womb audio module 1148 to simulate the sounds of thefetus within the womb of the mother. For example, in some embodimentsthe womb audio module 1148 is configured to simulate the heart beat ofthe fetus within the womb.

The patient simulator 1102 also includes a compressor 1150. Thecompressor 1150 is utilized to provide a compressed air supply to thevarious pneumatic devices of the simulator 1102. For example, in someembodiments the compressor 1150 is utilized to provide air to modulesfor simulating the lungs, pulses, contractions, tummy pressure,seizures, eye dilation, blinking, and/or other aspects of the patientsimulator 1102. In some embodiments, the compressor 1150 providespressurized air to one or more air reservoirs or accumulators that arethen connected to the various pneumatic modules of the simulator 1102.In that regard, the air reservoirs may maintain different air pressuressuch that different pneumatic modules are connected to the air reservoirwith the appropriate air pressure for its application. In someinstances, the pneumatic modules of the patient simulator 1102 thatutilize the compressor 1150 are configured to run at a relatively lowair pressure, e.g., less than 10 psi in some embodiments and less than 5psi in other embodiments. In some instances, the simulator 1102 includestwo accumulators with one of the accumulators maintaining an airpressure of approximately 5 psi and the other accumulator maintaining anair pressure of approximately 1 psi. In other embodiments, theaccumulators maintain other air pressures. Generally, however, thepatient simulator 1102 and its associated components are configured tooperate at low pressures, which helps prevent the introduction of waterinto the simulator associated with high pressure systems. Theintroduction of water into the simulator that results from using highpressure systems can cause damage to the simulator, increase themaintenance costs, and require additional components to remove or limitthe amount of water within the simulator.

Further, the compressor 1150 is sized to fit entirely within thesimulator 1102. In that regard, the compressor 1150 operates quietly soas not to interfere with the other simulation aspects of the simulator1102. Accordingly, in some instances a muffler system is utilized tominimize the noise generated by the compressor 1150. The muffler systemis utilized on the input, output, and/or both sides of the compressor insome embodiments. Further, the compressor 1150 is self-cooling in someinstances. In one such embodiment, the compressor 1150 includes aplurality of metal pipes surrounding at least the compressor motor thatintake air is passed through. The intake air passing through the metalpipes helps to dissipate the heat generated by the compressor 1150.Accordingly, the compressor 1150 is able to operate entirely within thesimulator 1102 without overheating or disturbing the other simulationaspects of the simulator. This allows the simulator 1102 to be fullyfunctional without attachment to a noisy, external, high pressurecompressor.

The patient simulator 1102 also includes a compression module 1152. Thecompression module 1152 is configured to monitor the force of chestcompressions applied to the simulator 1102. In that regard, thecompression module 1152 is configured to monitor the pressure appliedand based on that pressure determine whether the pressure is too high,too low, or within the desired range. The compression module 1152 is incommunication with the master module 1106, such that the determinationof whether the correct pressure is being applied is relayed to thecontrol system 1104. In some embodiments, the simulator 1102 will trendtowards recovery or further complications based on whether the correctpressure is applied. For example, if the chest compressions are withinthe desired range of pressures then the patient simulator may show signsof recovery. On the other hand, if the chest compressions are outsidethe desired range of pressures then the patient simulator may developadditional problems or symptoms and/or make it more difficult to recoverthe simulator from the present symptoms.

The patient simulator 1102 also includes a right lung valve 1154, a leftlung valve 1156, and a breathing valve 1158. Together the right lungvalve 1154, the left lung valve 1156, and the breathing valve 1158control the flow of air into and out of the lungs of the simulator 1102.In that regard, each of the valves 1154, 1156, and 1158 comprise apneumatic valve. In some embodiments, the breathing valve 1158 isutilized to control the respiratory rate of the simulator 1102. In thatregard, the breathing valve 1158 opens and closes in order for the lungsto inflate and deflate at the desired rate. The right lung valve 1154and the left lung valve 1156 are utilized to selectively disable theright and/or left lungs, respectively. Accordingly, in some embodimentswhen the right lung valve is opened it closes a 3-way air pilot valvesuch that air cannot flow from the breathing valve into the right lung.In such instances, air flows from the breathing valve solely into theleft lung. Factors such as disablement of the lungs, respiratory rate,respiratory pattern, inspiratory rate, and/or disablement of the left orright lung is controlled by the valves 1154, 1156, and 1158 based onsignals received from the control system 1104 via the master module1106.

The patient simulator 1102 also includes an ECG module 1160. The ECGmodule is configured to emit an electrical signal that simulates theelectrical activity of the heart of the simulator 1102. In someembodiments, the ECG modules are configured to provide signalsassociated with each of the 12 leads such that a 12-lead ECG signal isavailable to the user. In some embodiments, the ECG module 1160 isconfigured to emit signals that simulate the presence of a myocardialinfarction in various parts of the heart. In some embodiments, theposition of the myocardial infarction is selected via the control system1104. Accordingly, the ECG module is utilized to train users to identifythe onset of heart attacks and/or the associated symptoms identifiablevia an ECG. The electrical signal of the ECG module is detectable bystandard ECG equipment.

The patient simulator 1102 also includes a delivery motor module 1162.The delivery motor module 1162 is utilized to control the delivery ofthe fetus or baby from the simulator 1102 in embodiments where thesimulator is a birthing simulator. In that regard, the delivery motormodule 1162 is utilized to control the position of the baby within themother simulator. Upon activation by the delivery motor module 1162, thedelivery mechanism urges the baby out of the mother's womb. In someembodiments, the delivery mechanism will deliver the baby at leastpartially out of the mother's womb where the user completes delivery ofthe baby. In some embodiments, the delivery mechanism rotates the babyas it travels down the birth canal.

The patient simulator 1102 also includes a ventilation module 1164. Theventilation module 1164 is configured to monitor the use of aventilation device applied to the simulator 1102. The ventilation deviceis a bag-valve mask in some instances. In other instances, theventilation device is a user's mouth, such as in mouth-to-mouthresuscitation. The ventilation module 1164 is configured to monitor thepressure applied by the ventilation device and based on that pressuredetermine whether the pressure is too high, too low, or within thedesired range. The ventilation module 1164 is in communication with themaster module 1106, such that the determination of whether the correctpressure is being applied is relayed to the control system 1104. In someembodiments, the simulator 1102 will trend towards recovery or furthercomplications based on whether the correct pressure is applied. Forexample, if the ventilation is within the desired range of pressuresthen the patient simulator may show signs of recovery. On the otherhand, if the ventilation is outside the desired range of pressures thenthe patient simulator may develop additional problems or symptoms and/ormake it more difficult to recover the simulator from the presentsymptoms.

The patient simulator 1102 also includes a femoral pulse module 1166.The femoral pulse module 1166 is a pneumatic module for simulating thefemoral pulse of the simulator 1102. The patient simulator 1102 alsoincludes a right pedal pulse module 1168 and a left pedal pulse module1170. The left and right pedal pulse modules 1168, 1170 are configuredto simulate the pedal pulses of the simulator 1102. In that regard, insome embodiments the pedal pulse modules 1168, 1170 are electricalmodules configured to simulate the pedal pulses. In other embodiments,the pedal pulse modules 1168, 1170 are pneumatic modules configured tosimulate the pedal pulses. The patient simulator 1102 also includes aright radial pulse module 1172 and a left radial pulse module 1174. Theright and left radial pulse modules 1172, 1174 are pneumatic modules forsimulating the radial pulses of the simulator 1102. The patientsimulator 1102 also includes a bilateral pulse module 1176. The patientsimulator 1102 also includes an umbilical pulse module 1178. The patientsimulator 1102 also includes a multifunction module 1180 configured forsimulating heart sounds, k-sounds, and/or pulses of the simulator. Thepatient simulator 1102 also includes multifunction module 1182 for useas a lung valve and/or breathing valve in the simulator 1102.

The patient simulator 1102 also includes a right blood pressure cuffmodule 1184 and a left blood pressure cuff module 1186. The left andright blood pressure cuff modules 1184 and 1186 are pressure modulesconfigured to allow a user to take a simulated blood pressure of thepatient simulator 1102. The blood pressure cuff modules 1184 and 1186are configured for use with standard blood pressure monitors in someembodiments.

The patient simulator 1102 also includes a plurality of color changemodules 1188, 1190, and 1192. In that regard, the color change module1188 is configured for controlling color change around the lips of thesimulator 1102; the color change module 1190 is configured forcontrolling color change around the fingers of the simulator; and thecolor change module 1192 is configured for controlling color changearound the toes of the simulator. The color change modules 1188, 1190,and 1192 are utilized in some embodiments to simulate cyanosis of thepatient simulator. Accordingly, the color change modules 1188, 1190, and1192 are configured to simulate different levels of cyanosis of thepatient simulator 1102. In that regard, the degree of cyanosis isdetermined by the control system 1104 and/or a user of the controlsystem 1104 in some embodiments. The degree of cyanosis maytrend—increase and/or decrease—based on a variety of parametersincluding the efficacy of any treatments administered. In someembodiments, the trending is controlled manually via the control system1104. In other embodiments, the trending is at least partiallycontrolled by a physiological simulator software application of thecontrol system 1104.

The patient simulator 1102 also includes an intubation module 1194. Theintubation module 1194 is configured to monitor intubation of thepatient simulator 1102. In that regard, the depth of proper intubationfor the patient simulator 1102 will depend on the size and/or age of thepatient simulator. In that regard, the intubation module 1194 isassociated with a particular size of patient simulator to determine theproper intubation depth. In some embodiments, the intubation module 1194utilizes an optical sensor to monitor the depth of an intubation tubewithin the trachea of the patient simulator 1102. In some embodiments,the intubation module 1194 utilizes a pair of optical sensors spacedapart from one another to define the acceptable range of intubationdepths. The first optical sensor is utilized to detect the presence ofan intubation tube as it reaches the beginning of the acceptable rangeof depths. The second optical sensor is utilized to detect when theintubation tube has been advanced beyond the acceptable range of depths.In some embodiments, the patient simulator 1102 also includes a reversebreathing valve module 1196 and a bypass breathing valve module 1198.

The patient simulator 1102 also includes a right arm motion module 1200and a left arm motion module 1202. The right and left arm motion modules1200 and 1202 are configured to activate movement of the left and rightarms of the simulator 1102. In some embodiments, the right and left armmodules 1200 and 1202 are particularly suited for use in a newborn sizedsimulator. In some embodiments, the right and left arm motion modules1200 and 1202 comprise pneumatic modules that are utilized to inflateand deflate air bags associated with the arms of the simulator. In thatregard, in some instances the air bags comprise accordion bags such thatas the bags are filled with air they expand outwardly in a predeterminedprofile. By inflating and deflating the bags with the modules, the armsof the simulator are moved. The bags are associated with a pivotassembly positioned adjacent the simulator's elbow in some instances. Inone particular embodiment, inflation and deflation of the bags causesthe simulator's arm to bend or straighten via the pivot assembly. Asmovement of the arms is actuated by a pneumatic module and the inflationand deflation of air bags, a user can restrain movement of the armswithout causing physical damage to the simulator in contrast to somemechanically actuated systems. In some embodiments, the arm motionmodules are configured to activate a mechanical system or motor formoving the simulator's arms. In some embodiments, the mechanical systemincludes a safety to prevent damage to the arm motion modules andassociated components if and when the intended arm motion is restrictedby a user.

In some embodiments, the patient simulator 1102 includes left and rightleg motion modules that operate in a similar manner to the arm motionmodules. In that regard, the right and left leg motion modules areconfigured to activate movement of the left and right legs of thesimulator 1102. In some embodiments, the right and left leg modules areparticularly suited for use in a newborn sized simulator. In someembodiments, the right and left leg motion modules comprise pneumaticmodules that are utilized to inflate and deflate air bags associatedwith the legs of the simulator. In that regard, in some instances theair bags comprise accordion bags such that as the bags are filled withair they expand outwardly to a predetermined profile. By inflating anddeflating the bags with the modules, the legs of the simulator aremoved. The bags are associated with a pivot assembly positioned adjacentthe simulator's knee in some instances. In one particular embodiment,inflation and deflation of the bags causes the simulator's leg to bendor straighten via the pivot assembly. As movement of the legs isactuated by a pneumatic module and the inflation and deflation of airbags, a user can restrain movement of the legs without causing physicaldamage to the simulator, in contrast to some mechanically actuatedsystems. In some embodiments, the leg motion modules are configured toactivate a mechanical system or motor for moving the simulator's legs.In some embodiments, the mechanical system includes a safety to preventdamage to the leg motion modules and associated components if and whenthe intended leg motion is restricted by a user.

The patient simulator 1102 also includes a rotation module 1204. Therotation module 1204 is configured to rotate the fetus or baby withinthe mother simulator. Particularly, the rotation module 1204 isconfigured to actuate a motor or other device for controlling therotation of the baby as it travels within the birth canal of the mothersimulator. The patient simulator 1102 also includes a load cell module1206. In some embodiments, the load cell module is positioned on adelivery mechanism of the mother simulator and is configured to monitorthe amount of pressure being exerted on the baby during birthing. Inthat regard, the load cell module is positioned adjacent the attachmentpoint of the baby to the delivery mechanism in some embodiments. Inother embodiments, the load cell module is positioned within or on thebaby itself. Generally, the signals generated by the load cell arecommunicated to the control system 1104 via the master module 1106.Based on the sensed pressures or forces on the load cell, adetermination can be made regarding whether the amount of force beingused in removing the baby from the birth canal is within a desiredrange.

The patient simulator 1102 also includes a tummy pressure module 1208.The tummy pressure module 1208 is utilized to control the firmness ofthe mother simulator's tummy. In that regard, the tummy pressure module1208 is configured to sense the amount of pressure within the mother'stummy. Based on a desired pressure, the tummy pressure module 1208determines whether pressure in the tummy should be increased, decreased,or remain the same. If the pressure should be increased, then the tummypressure module 1208 activates the flow of air to the tummy through apneumatic valve. In some embodiments, the tummy pressure module 1208 isin communication with an air reservoir or compressor for providing theair flow to the tummy. If the pressure should be decreased, then thetummy pressure module 1208 activates the release of air from the tummy.The desired pressure is provided by the control system 1104 in someinstances. In that regard, a user or teacher can define the tummypressure via the control system 1104 in some embodiments.

The patient simulator 1102 also includes a baby release module 1210. Thebaby release module 1210 is configured to selectively release the babyfrom the delivery mechanism within the maternal simulator. In thatregard, the baby release module 1210 is remotely activated by a user orteacher via the control system 1104 in some instances. In otherinstances, the baby release module 1210 is activated based on theposition of the delivery mechanism and/or baby within the birth canal.That is, once the baby reaches a certain position and/or orientationwith the birth canal the baby release module activates to release theengagement between the delivery mechanism and the baby.

The patient simulator 1102 also includes a tongue control module 1212.The tongue control module 1212 is a pneumatic module configured toselectively inflate and/or deflate the tongue to partially obstruct anairway of the simulator 1102. In that regard, the tongue control module1212 is controlled via the control system 1104 in some instances.Accordingly, a user or teacher can partially block or unblock the airwayas desired. The patient simulator 1102 also includes a larynges controlmodule 1214 and a pharynges control module 1216. The larynges controlmodule 1214 is configured to open and close the larynx to partiallyobstruct the airway of the simulator. Similarly, the pharynges controlmodule 1216 is configured to urge the posterior wall of the pharynxanteriorly to partially obstruct the airway of the simulator. Thelarynges control module 1214 and the pharynges control module 1216 arealso controlled via the control system 1104 in some instances.Accordingly, a user or teacher can also partially block or unblock theairway as desired with these features as well.

The patient simulator 1102 also includes a pneumothorax module 1218 anda pneumothorax release module 1220. The pneumothorax module 1218 isconfigured to simulate the presence of a pneumothorax (collapsed lung)in the left lung or the right lung. The pneumothorax release module 1220is configured to return the simulator 1102 to normal lung conditionwithout a pneumothorax. The onset and alleviation of the pneumothoraxcondition is controlled via the control system 1104.

The patient simulator 1102 also includes eye module 1222. The eye module1222 is configured to control the patient's simulated eyes includingblinking and pupil dilation. The eye module 1222 includes a plurality ofmodules for controlling these functions in some embodiments. Forexample, see FIGS. 46-49 and accompanying description for one suchembodiment. In some embodiments, the pupil dilation of each of thesimulator's eyes is controlled at least partially based on the amount oflight received by an optical sensor positioned within the eye. Themaximum size of the pupil and/or the rate of change or dilation of thepupil are controlled by the control system 1104 in some instances.Similarly, the rate, pattern, and speed of blinking are controlled bythe control system 1104 in some instances. In some instances the rate ofblinking ranges from 5 blinks per minute to 30 blinks per minute.However, ranges outside of this are used in some embodiments. Further,the eyes can be maintained in an open position or a closed position. Thespeed of the blinks can be controlled as well. In some instances, thespeed of each blink from open to closed to open is approximately 200 ms.However, the speed of the blinks can be increased or decreased asdesired in some embodiments.

The patient simulator 1102 also includes a right side seizure module1224 and a left side seizure module 1226. The right and left seizuremodules 1224 and 1226 are configured to simulate a seizure of thepatient on the corresponding sides of the patient's body. Accordingly,the seizure modules 1224 and 1226 are configured to cause shaking and/orconvulsing in some embodiments. Also, the seizure modules 1224 and 1226are used together in some instances to simulate a full body seizure. Insome instances activation of the seizure modules 1224 and 1226 iscontrolled via the control system 1104.

The patient simulator 1102 also includes a rotational module 1228 and apositional module 1230. The rotational module 1228 and the positionalmodule 1230 are configured to provide positional data regarding the babywithin the birthing canal of a maternal simulator. In that regard, therotational module 1228 and positional module 1230 are particularlyconfigured to monitor the relative rotation of the baby within the birthcanal. In some embodiments, the rotational module 1228 is positioned onthe delivery mechanism of the maternal simulator and the positionalmodule 1230 is positioned within a portion of the baby. In someinstances, the positional module 1230 is positioned within the head ofthe baby. The rotation of the baby is determined by comparing therelative rotation of the positional module 1230 on the baby to therotational module 1228. In some instances, the rotational module 1230 issubstantially fixed rotationally. Based on the relative rotation of themodule 1230 compared to the module 1228 the rotational position of thebaby can be determined. The rotational data from the modules 1228 and1230 is communicated to the control system 1104 in some embodiments. Inone such embodiment, a user or teacher utilizes the positional androtational information to determine when to release the baby from thedelivery mechanism of the maternal simulator. In other embodiments, thecontrol system 1104 automatically releases the baby from the deliverymechanism based on a correct orientation and position of the baby withinthe birth canal. The patient simulator 1102 also includes a pneumaticmodule 1232. The pneumatic module 1232 is configured to control apneumatically actuated portion of the simulator 1102.

Each of the various modules is connected to the master module 1106 via apower wire 1234, a ground wire 1236, and a 2-way communication wire1238. In that regard, the master module 1106 can control the activation,deactivation, and power consumption of each of the modules. In someembodiments, the master module 1106 is controlled via a software programof the control system 1104. In other embodiments, the modules aredirectly connected to a power supply. In some embodiments, the mastermodule 1106 is in wireless communication with one or more of themodules. In some embodiments, communication to one or more of themodules is 1-way communication. In some embodiments, the modulesthemselves are interconnected via the communication wire 1238 or anadditional communication wire. In that regard, in some instances anon-master module acts as a master module for a subset of modules.

Referring now to FIG. 30, shown therein is a diagrammatic schematic viewof a patient simulator 1250 according to one embodiment of the presentdisclosure incorporating aspects of the patient simulator system 1100described above. For example, the patient simulator 1250 is incommunication with a control system 1104 and a power source 1122.

The patient simulator 1250 is particularly suited for simulating abirthing sequence. In that regard, the patient simulator 1250 includes amaternal simulator in some embodiments. In some embodiments, the patientsimulator 1250 has a fetal simulator associated therewith for performingsimulated deliveries. The patient simulator 1250 includes a plurality ofmodules for performing the various functions of the simulator. In someembodiments, each of the modules controls a particular function or groupof functions of the simulator 1250. In that regard, the modules areappropriately sized for positioning within various portions of thesimulator 1250. In some embodiments, the modules are positionedthroughout the simulator adjacent to the region or area of the simulator1250 related to the module's specific function or the associated bodypart of the simulator. Accordingly, the modules are distributedthroughout the simulator rather than being grouped onto a singlemotherboard. In some embodiments, each of the modules is incommunication with a master module 1252. In some embodiments the mastermodule 1252 is configured to provide and control the power delivered tothe modules and facilitate communication with and among the modules.

In the current embodiment, the patient simulator 1250 is shown inwireless communication with the control system 1104. In that regard, thepatient simulator 1250 includes a wireless communication module 1254 andan antenna 1256 similar to those described above with respect to FIG.29. The patient simulator 1250 also includes a power supply 1258. In thepresent embodiment, the power supply 1258 is a rechargeable battery. Inthat regard, the power supply 1258 is connected to a charger 1260. Thecharger 1260 is configured to recharge the power supply 1258. In thatregard, the charger 1260 is configured for communication with anexternal power supply 1122. In the current embodiment, the externalpower supply 1122 is a wall outlet or standard line power supply. Inother embodiments, the external power supply 1122 is configured forwireless communication with the charger 1260 or power supply 1258 suchthat the power supply may be recharged wirelessly, such as by inductivecoupling or other wireless charging means. In some embodiments, thecharger 1260 comprises a backup power supply.

The patient simulator 1250 includes a voice module 1262. The voicemodule 1262 is in communication with the master module 1252, which is incommunication with the control system 1104. The voice module 1262 is anaudio module configured to emit sounds simulating a patient's voice. Inthat regard, the particular sounds emitted by the voice module 1262 arecontrolled in some embodiments by a user through the control system1104. In some embodiments, the control system 1104 includes a pluralityof stored or prerecorded sounds that may be selected from and playedback by the voice module 1262 as discussed above in greater detail withrespect to FIG. 29. In some embodiments, the control system 1104 is incommunication with the voice module 1262 such that a user or teacherspeaks into a microphone or other sound communication device associatedwith the control system and the teacher's words or sounds are emittedfrom the voice module 1262. In some embodiments, the user or teacher'sinput may be conditioned using audio amplifiers or sound boards to alterthe sound of the voice emitted from the voice module 1262. For example,in some embodiments the input sound is conditioned to simulate a hoarsepatient, a patient with a blocked air passage, or other mental orphysical medical condition of the patient. In that regard, the teachermay selectively activate various types of audio conditioning based on adesired effect. The voice module 1262 and the corresponding voicesimulation are utilized as part of an overall medical scenariosimulation in some embodiments.

The patient simulator 1250 also includes a heart sound module 1264. Theheart sound module 1264 is an audio module configured to emit sounds tosimulate the natural sounds of a patient's heart. In that regard, thesounds of the heart sound module 1264 include one or more of sounds tosimulate the patient's heart rate and cardiac rhythm (e.g., sinus,atrial tachycardia, multifocal atrial tachycardia, atrial flutter,atrial fibrillation, junctional, idioventricular, ventriculartachycardia (uni.), ventricular tachycardia (multi.), supraventriculartachycardia, ventricular flutter, ventricular fibrillation, agonal,asystole, LBBB, RBBB, 1^(st) degree AVB, 2^(nd) degree AVB (Type I),2^(nd) degree AVB (Type II), 3^(rd) degree AVB, Q-wave infarction, STsegment elevation, ST segment depression, T-wave inversion, atrialpaced, AV sequential paced, vent. Pacemaker (artificial), and/or othercardiac rhythms). Further, the heart sounds may be normal, distant,non-existent, include a systolic murmur, S3, and/or S4. The controlsystem 1104 and/or a user utilizing the control system determines whatheart sounds and at what rate the sounds are produced in someembodiments. The sounds produced by the heart sound module 1264 aredetectable via use of a stethoscope in some instances. In someembodiments, at least a portion of the heart sound module 1264—such as aspeaker—is positioned within the simulator 1250 where the natural heartwould be.

The patient simulator 1250 also includes lung sound modules 1266, 1268,1270, 1272, 1274, 1278, 1280, and 1282. In particular, lung sound module1266 is utilized to simulate sounds of the upper right lung towards thefront of the simulator 1250; lung sound module 1268 is utilized tosimulate sounds of the upper left lung towards the front of thesimulator; lung sound module 1270 is utilized to simulate sounds of thelower right lung towards the front of the simulator; lung sound module1272 is utilized to simulate sounds of the lower left lung towards thefront of the simulator; lung sound module 1274 is utilized to simulatesounds of the upper right lung towards the back of the simulator; lungsound module 1278 is utilized to simulate sounds of the upper left lungtowards the back of the simulator; lung sound module 1280 is utilized tosimulate sounds of the lower right lung towards the back of thesimulator; lung sound module 1282 is utilized to simulate sounds of thelower left lung towards the front of the simulator.

Each of the lung sound modules 1266, 1268, 1270, 1272, 1274, 1278, 1280,and 1282 is an audio module configured to produce sounds to simulate thenatural sounds of a patient's lungs. In that regard, the lung soundmodules 1266, 1268, 1270, 1272, 1274, 1278, 1280, and 1282 areconfigured to produce one or more of the following lung sounds in someembodiments: normal, none, wheezing, inspiration squeaks, crackles,rails, and/or other lung sounds. Further, the combination of lung soundmodules 1266, 1268, 1270, 1272, 1274, 1278, 1280, and 1282 are utilizedto simulate respiratory patterns including, but not limited to normal,Kussmaul's, Cheyne-Stokes, Biot's, apneusic, and/or other respiratorypatterns. The combination of lung sound modules 1266, 1268, 1270, 1272,1274, 1278, 1280, and 1282 are also utilized to simulate the respiratoryrate of the patient. In that regard, the respiratory rate may be set ata constant rate and/or be set to change over time.

The patient simulator 1250 also includes a valve array module 1276. Thevalve array module includes a plurality of pneumatic valves and isconfigured to control aspects of the breathing system. In someembodiments, the valve array module 1276 is configured to control thesimulation of a pneumothorax condition in the left or right lung of thesimulator 1250.

The patient simulator 1250 also includes a K-sound module 1284 for theright arm of the simulator and a K-sound module 1286 for the left arm ofthe simulator. Each of the K-sound modules 1284 and 1286 are configuredto produce a simulated K-sound (Korotkoff sound). In that regard, theK-sound modules 1284 and 1286 are utilized to allow a user to take theblood pressure of the patient simulator 1250 in some embodiments.Accordingly, the K-sounds produced by the modules 1284 and 1286 aredetermined based on a simulated heart rate and blood pressure. In someinstances, the heart rate and blood pressure of the patient simulator1250 are provided by a user or teacher via the control system 1104.

The patient simulator 1250 also includes a womb audio module 1288 tosimulate the sounds of the fetus within the womb of the mother. In someembodiments the womb audio module 1148 is configured to simulate theheart beat of the fetus within the womb. The patient simulator alsoincludes a pupil dilation module 1290. The pupil dilation module 1290 isconfigured to control the dilation of the pupils of the simulator'seyes. In some embodiments, the pupil dilation of each of the simulator'seyes is controlled at least partially based on the amount of lightreceived by an optical sensor positioned within the eye. Further, themaximum size of the pupil and/or the rate of change or dilation of thepupil are controlled by the control system 1104 in some instances. Insome instances the parameters of the pupil dilation are selected tosimulate a specific medical condition.

The patient simulator 1250 also includes a compression module 1292. Thecompression module 1292 is configured to monitor the force of chestcompressions applied to the simulator 1250. In that regard, thecompression module 1292 is configured to monitor the pressure appliedand based on that pressure determine whether the pressure is too high,too low, or within the desired range. The compression module 1292 is incommunication with the master module 1252, such that the determinationof whether the correct pressure is being applied is relayed to thecontrol system 1104. In some embodiments, the simulator 1250 will trendtowards recovery or further complications based on whether the correctpressure is applied. For example, if the chest compressions are withinthe desired range of pressures then the patient simulator may show signsof recovery. On the other hand, if the chest compressions are outsidethe desired range of pressures then the patient simulator may developadditional problems or symptoms and/or make it more difficult to recoverthe simulator from the present symptoms.

The patient simulator 1250 also includes a right lung valve 1294, a leftlung valve 1296, and a breathing valve 1298. Together the right lungvalve 1294, the left lung valve 1296, and the breathing valve 1298control the flow of air into and out of the lungs of the simulator 1250.In that regard, each of the valves 1294, 1296, and 1298 comprise apneumatic valve. In some embodiments, the breathing valve 1298 isutilized to control the respiratory rate of the simulator 1250. In thatregard, the breathing valve 1298 opens and closes in order for the lungsto inflate and deflate at the desired rate. The right lung valve 1294and the left lung valve 1296 are utilized to selectively disable theright and/or left lungs, respectively. Accordingly, in some embodimentswhen the right lung valve 1294 is opened it closes a 3-way air pilotvalve such that air cannot flow from the breathing valve into the rightlung. In such instances, air flows from the breathing valve solely intothe left lung. The left lung valve 1296 operates in a similar manner insome embodiments. Factors such as disablement of the lungs, respiratoryrate, respiratory pattern, inspiratory rate, and/or disablement of theleft or right lung are controlled by the valves 1294, 1296, and 1298based on signals received from the control system 1104 via the mastermodule 1252.

The patient simulator 1250 also includes an ECG module 1300 or rhythmemulator. The ECG module is configured to emit an electrical signal thatsimulates the electrical activity of the heart of the simulator 1250. Insome embodiments, the ECG modules are configured to provide signalsassociated with each of the 12 leads such that a 12-lead ECG signal isavailable to the user. In some embodiments, the ECG module 1300 isconfigured to emit signals that simulate the presence of a myocardialinfarction in various parts of the heart. In some embodiments, theposition of the myocardial infarction is selected via the control system1104. Accordingly, the ECG module is utilized to train users to identifythe onset of heart attacks and/or the associated symptoms identifiablevia an ECG. The electrical signal of the ECG module is detectable bystandard ECG equipment.

The patient simulator 1250 also includes a delivery motor module 1302.The delivery motor module 1302 is utilized to control the delivery ofthe fetus or baby from the simulator 1250. In that regard, the deliverymotor module 1302 is utilized to control the position of the baby withinthe mother simulator. Upon activation by the delivery motor module 1302,the delivery mechanism urges the baby out of the mother's womb. In someembodiments, the delivery mechanism will deliver the baby at leastpartially out of the mother's womb where the user completes delivery ofthe baby. In some embodiments, the delivery mechanism rotates the babyas it travels down the birth canal.

The patient simulator 1250 also includes a ventilation module 1304. Theventilation module 1304 is configured to monitor the use of aventilation device applied to the simulator 1250. The ventilation deviceis a bag-valve mask in some instances. In other instances, theventilation device is a user's mouth, such as in mouth-to-mouthresuscitation. The ventilation module 1304 is configured to monitor thepressure applied by the ventilation device and based on that pressuredetermine whether the pressure is too high, too low, or within thedesired range. The ventilation module 1304 is in communication with themaster module 1252, such that the determination of whether the correctpressure is being applied is relayed to the control system 1104. In someembodiments, the simulator 1250 will trend towards recovery or furthercomplications based on whether the correct pressure is applied. Forexample, if the ventilation is within the desired range of pressuresthen the patient simulator may show signs of recovery. On the otherhand, if the ventilation is outside the desired range of pressures thenthe patient simulator may develop additional problems or symptoms and/ormake it more difficult to recover the simulator from the presentsymptoms.

The patient simulator 1250 also includes a femoral pulse module 1306.The femoral pulse module 1306 is a pneumatic module for simulating thefemoral pulse of the simulator 1250. The patient simulator 1250 alsoincludes a right pedal pulse module 1308 and a left pedal pulse module1310. The left and right pedal pulse modules 1308, 1310 are configuredto simulate the pedal pulses of the simulator 1250. In that regard, insome embodiments the pedal pulse modules 1308, 1310 are electricalmodules configured to simulate the pedal pulses. In other embodiments,the pedal pulse modules 1308, 1310 are pneumatic modules configured tosimulate the pedal pulses. The patient simulator 1250 also includes aright radial pulse module 1312 and a left radial pulse module 1314. Theright and left radial pulse modules 1312, 1314 are pneumatic modules forsimulating the radial pulses of the simulator 1250. The patientsimulator 1250 also includes a palpable pulse module 1316.

The patient simulator 1250 also includes eyelid module 1318. The eyelidmodule 1318 is configured to control the blinking of the patient'ssimulated eyes. The rate, pattern, and speed of blinking are controlledby the control system 1104 in some instances. In some instances the rateof blinking ranges from 5 blinks per minute to 30 blinks per minute. Inother embodiments, ranges outside of this are used. Further, the eyescan be maintained in an open position or a closed position. The speed ofthe blinks can be controlled as well. In some instances, the elapsedtime or speed of each blink from open to closed to open is approximately200 ms. However, the speed of the blinks can be increased or decreasedas desired in some embodiments.

The patient simulator 1250 also includes an encoder module 1320 and anencoder module 1336. The encoder modules 1320 and 1336 are configured toprovide positional data regarding the baby within the birthing canal ofa maternal simulator. In that regard, the encoder modules 1320 and 1336are configured to monitor the relative rotation of the baby within thebirth canal in some instances. In some embodiments, the encoder module1336 is positioned on the delivery mechanism of the maternal simulatorand the encoder module 1320 is positioned within a portion of the babyor fetal simulator. In some instances, the encoder module 1320 ispositioned within the head of the baby. The rotation of the baby isdetermined by comparing the relative rotation of the encoder module 1320on the baby to the encoder module 1336. In some instances, the module1336 is substantially fixed rotationally. Based on the relative rotationof the module 1320 compared to the module 1336 the rotational positionof the baby can be determined. In some embodiments, the modules 1320 and1336 are optical devices. The rotational data from the modules 1320 and1336 is communicated to the control system 1104 in some embodiments. Inone such embodiment, a user or teacher utilizes the positional androtational information to determine when to release the baby from thedelivery mechanism of the maternal simulator. In other embodiments, thecontrol system 1104 automatically releases the baby from the deliverymechanism based on a correct orientation and position of the baby withinthe birth canal.

The patient simulator 1250 also includes a left blood pressure cuffmodule 1322 and a right blood pressure cuff module 1324. The left andright blood pressure cuff modules 1322 and 1324 are pressure modulesconfigured to allow a user to take a simulated blood pressure of thepatient simulator 1250. The blood pressure cuff modules 1322 and 1324are configured for use with standard blood pressure monitors in someembodiments.

The patient simulator 1250 also includes a baby release module 1326. Thebaby release module 1326 is configured to selectively release the babyfrom the delivery mechanism within the maternal simulator. In thatregard, the baby release module 1326 is remotely activated by a user orteacher via the control system 1104 in some instances. In otherinstances, the baby release module 1326 is activated based on theposition of the delivery mechanism and/or baby within the birth canal.That is, once the baby reaches a certain position and/or orientationwith the birth canal the baby release module activates to release theengagement between the delivery mechanism and the baby.

The patient simulator 1250 also includes a plurality of color changemodules 1328, 1330, and 1332. In that regard, the color change module1328 is configured for controlling color change around the lips of thesimulator 1250; the color change module 1330 is configured forcontrolling color change around the fingers of the simulator; and thecolor change module 1332 is configured for controlling color changearound the toes of the simulator. The color change modules 1328, 1330,and 1332 are utilized in some embodiments to simulate cyanosis of thepatient simulator. Accordingly, the color change modules 1328, 1330, and1332 are configured to simulate different levels of cyanosis of thepatient simulator 1250. In that regard, the degree of cyanosis isdetermined by the control system 1104 and/or a user of the controlsystem 1104 in some embodiments. The degree of cyanosis maytrend—increase and/or decrease—based on a variety of parametersincluding the efficacy of any treatments administered. In someembodiments, the trending is controlled manually via the control system1104. In other embodiments, the trending is at least partiallycontrolled by a physiological simulator software application of thecontrol system 1104.

The patient simulator 1250 also includes an intubation module 1334. Theintubation module 1334 is configured to monitor intubation of thepatient simulator 1250. In that regard, the depth of proper intubationfor the patient simulator 1250 will depend on the size and/or age of thepatient simulator. In that regard, the intubation module 1334 isassociated with a particular size of patient simulator to determine theproper intubation depth. In some embodiments, the intubation module 1334utilizes an optical sensor to monitor the depth of an intubation tubewithin the trachea of the patient simulator 1250. In some embodiments,the intubation module 1334 utilizes a pair of optical sensors spacedapart from one another to define the acceptable range of intubationdepths. The first optical sensor is utilized to detect the presence ofan intubation tube as it reaches the beginning of the acceptable rangeof depths. The second optical sensor is utilized to detect when theintubation tube has been advanced beyond the acceptable range of depths.In some embodiments, the patient simulator 1250 also includes apneumatic module 1338 for controlling a pneumatic device of thesimulator.

The patient simulator 1250 also includes a right arm motion module 1340and a left arm motion module 1342. The right and left arm motion modules1340 and 1342 are configured to activate movement of the left and rightarms of the simulator 1250. In some embodiments, the right and left armmodules 1340 and 1342 are used in the fetal simulator. In otherembodiments, the right and left arm modules 1340 and 1342 are used inboth the maternal simulator and the fetal simulator. In someembodiments, the right and left arm motion modules 1340 and 1342comprise pneumatic modules that are utilized to inflate and deflate airbags associated with the arms of the simulator. In that regard, in someinstances the air bags comprise accordion bags such that as the bags arefilled with air they expand outwardly in a predetermined profile. Byinflating and deflating the bags with the modules, the arms of thesimulator are moved. The bags are associated with a pivot assemblypositioned adjacent the simulator's elbow in some instances. In oneparticular embodiment, inflation and deflation of the bags causes thesimulator's arm to bend or straighten via the pivot assembly. Asmovement of the arms is actuated by a pneumatic module and the inflationand deflation of air bags, a user can restrain movement of the armswithout causing physical damage to the simulator in contrast to somemechanically actuated systems. In some embodiments, the arm motionmodules are configured to activate a mechanical system or motor formoving the simulator's arms. In some embodiments, the mechanical systemincludes a safety to prevent damage to the arm motion modules andassociated components if and when the intended arm motion is restrictedby a user.

The patient simulator 1250 also includes a rotation module 1344. Therotation module 1344 is configured to rotate the fetus or baby withinthe mother simulator. Particularly, the rotation module 1344 isconfigured to actuate a motor or other device for controlling therotation of the baby as it travels within the birth canal of the mothersimulator. The patient simulator 1250 also includes a load cell module1346. In some embodiments, the load cell module is positioned on adelivery mechanism of the mother simulator and is configured to monitorthe amount of pressure being exerted on the baby during birthing. Inthat regard, the load cell module is positioned adjacent the attachmentpoint of the baby to the delivery mechanism in some embodiments. Inother embodiments, the load cell module is positioned within or on thebaby itself. Generally, the signals generated by the load cell arecommunicated to the control system 1104 via the master module 1252.Based on the sensed pressures or forces on the load cell, adetermination can be made regarding whether the amount of force beingused in removing the baby from the birth canal is within a desiredrange.

Finally, the patient simulator 1250 also includes a tummy pressuremodule 1348. The tummy pressure module 1348 is utilized to control thefirmness of the mother simulator's tummy. In that regard, the tummypressure module 1348 is configured to sense the amount of pressurewithin the mother's tummy. Based on a desired pressure, the tummypressure module 1348 determines whether pressure in the tummy should beincreased, decreased, or remain the same. If the pressure should beincreased, then the tummy pressure module 1348 activates the flow of airto the tummy through a pneumatic valve. In some embodiments, the tummypressure module 1348 is in communication with an air reservoir orcompressor for providing the air flow to the tummy. If the pressureshould be decreased, then the tummy pressure module 1348 activates therelease of air from the tummy. The desired pressure is provided by thecontrol system 1104 in some instances. In that regard, a user or teachercan define the tummy pressure via the control system 1104 in someembodiments.

Each of the various modules of the simulator 1250 is connected to themaster module 1252 via a power wire, a ground wire, and/or a 2-waycommunication wire. Accordingly, the master module 1252 is utilized tocontrol the activation, deactivation, and power consumption of themodules in some embodiments. In some embodiments, the master module 1252is controlled or directed via a software program of the control system1104. In some embodiments, the master module 1252 is in wirelesscommunication with one or more of the modules. In some embodiments, themodules themselves are interconnected via the communication wire or anadditional communication wire. In that regard, in some instances anon-master module acts as a master module for a subset of modules.

In some embodiments, the patient simulator 1250 also includes acompressor. The compressor is utilized to provide a compressed airsupply to the various pneumatic devices and modules of the simulator1250. For example, in some embodiments the compressor is utilized toprovide air to modules for simulating the lungs, pulses, contractions,tummy pressure, seizures, eye dilation, blinking, and/or other aspectsof the patient simulator 1250. In some embodiments, the compressorprovides pressurized air to one or more air reservoirs or accumulatorsthat are then connected to the various pneumatic modules of thesimulator 1250. In that regard, the air reservoirs may maintaindifferent air pressures such that different pneumatic modules areconnected to the air reservoir with the appropriate air pressure for itsapplication. In some instances, the pneumatic modules of the patientsimulator 1250 that utilize the compressor are configured to run at arelatively low air pressure, e.g., less than 10 psi in some embodimentsand less than 5 psi in other embodiments. In some instances, thesimulator 1250 includes two accumulators with one of the accumulatorsmaintaining an air pressure of approximately 5 psi and the otheraccumulator maintaining an air pressure of approximately 1 psi. In otherembodiments, the accumulators maintain other air pressures. Generally,however, the patient simulator 1250 and its associated components areconfigured to operate at low pressures, which helps prevent theintroduction of water into the simulator associated with high pressuresystems. The introduction of water into the simulator that results fromusing high pressure systems can cause damage to the simulator, increasethe maintenance costs, and require additional components to remove orlimit the amount of water within the simulator.

Further, the compressor is sized to fit entirely within the simulator1250 in some embodiments. In that regard, the compressor operatesquietly so as not to interfere with the other simulation aspects of thesimulator 1250 and, in particular, the audible simulation aspects.Accordingly, in some instances a muffler system is utilized to minimizethe noise generated by the compressor. The muffler system is utilized onthe input, output, and/or both sides of the compressor in someembodiments. Further, the compressor is self-cooling in some instances.In one such embodiment, the compressor includes a plurality of metalpipes surrounding at least the compressor motor that intake air ispassed through. The intake air passing through the metal pipes helps todissipate the heat generated by the compressor. Accordingly, thecompressor is able to operate entirely within the simulator 1250 withoutoverheating or disturbing the other simulation aspects of the simulator.This allows the simulator 1250 to be fully functional without attachmentto a noisy, external, high pressure compressor.

Referring now to FIG. 31, shown therein is a diagrammatic schematic viewof a patient simulator 1350 according to another embodiment of thepresent disclosure incorporating aspects of the patient simulator system1100 described above. For example, the patient simulator 1350 is incommunication with a control system 1104 and a power source 1122. Thepatient simulator 1350 is approximately the size of a five-year old insome embodiments. The patient simulator 1350 includes a plurality ofmodules for performing the various functions of the simulator. In someembodiments, each of the modules controls a particular function or groupof functions of the simulator 1350. In that regard, the modules areappropriately sized for positioning within various portions of thesimulator 1350. In some embodiments, the modules are positionedthroughout the simulator adjacent to the region or area of the simulator1350 related to the module's specific function or the associated bodypart of the simulator. Accordingly, the modules are distributedthroughout the simulator rather than being grouped onto a singlemotherboard. In some embodiments, each of the modules is incommunication with a master module 1352. In some embodiments the mastermodule 1352 is configured to provide and control the power delivered tothe modules and facilitate communication with and among the modules.

In the current embodiment, the patient simulator 1350 is shown inwireless communication with the control system 1104. In that regard, thepatient simulator 1350 includes a wireless communication module 1354 andan antenna 1356 similar to those described above with respect to FIGS.29 and 30. The patient simulator 1350 also includes a power supply 1358.In the present embodiment, the power supply 1238 is a rechargeablebattery. In that regard, the power supply 1358 is connected to a charger1360. The charger 1360 is configured to recharge the power supply 1358.In that regard, the charger 1360 is configured for communication with anexternal power supply 1122. In the current embodiment, the externalpower supply 1122 is a wall outlet or standard line power supply. Inother embodiments, the external power supply 1122 is configured forwireless communication with the charger 1360 or power supply 1358 suchthat the power supply may be recharged wirelessly, such as by inductivecoupling or other wireless charging means. In some embodiments, thecharger 1360 comprises a backup power supply.

The patient simulator 1350 includes a voice module 1362. The voicemodule 1362 is in communication with the master module 1352, which is incommunication with the control system 1104. The voice module 1362 is anaudio module configured to emit sounds simulating a patient's voice. Inthat regard, the particular sounds emitted by the voice module 1362 arecontrolled in some embodiments by a user through the control system1104. In some embodiments, the control system 1104 includes a pluralityof stored or prerecorded sounds that may be selected from and playedback by the voice module 1362 as discussed above in greater detail withrespect to FIG. 29. In some embodiments, the control system 1104 is incommunication with the voice module 1362 such that a user or teacherspeaks into a microphone or other sound communication device associatedwith the control system and the teacher's words or sounds are emittedfrom the voice module 1362. In some embodiments, the user or teacher'sinput may be conditioned using audio amplifiers or sound boards to alterthe sound of the voice emitted from the voice module 1362. For example,in some embodiments the input sound is conditioned to simulate a hoarsepatient, a patient with a blocked air passage, or other mental orphysical medical condition of the patient. In that regard, the teachermay selectively activate various types of audio conditioning based on adesired effect. The voice module 1362 and the corresponding voicesimulation are utilized as part of an overall medical scenariosimulation in some embodiments.

The patient simulator 1350 also includes a heart sound module 1364. Theheart sound module 1364 is an audio module configured to emit sounds tosimulate the natural sounds of a patient's heart. In that regard, thesounds of the heart sound module 1364 include one or more of sounds tosimulate the patient's heart rate and cardiac rhythm (e.g., sinus,atrial tachycardia, multifocal atrial tachycardia, atrial flutter,atrial fibrillation, junctional, idioventricular, ventriculartachycardia (uni.), ventricular tachycardia (multi.), supraventriculartachycardia, ventricular flutter, ventricular fibrillation, agonal,asystole, LBBB, RBBB, 1^(st) degree AVB, 2^(nd) degree AVB (Type I),2^(nd) degree AVB (Type II), 3^(rd) degree AVB, Q-wave infarction, STsegment elevation, ST segment depression, T-wave inversion, atrialpaced, AV sequential paced, vent. Pacemaker (artificial), and/or othercardiac rhythms). Further, the heart sounds may be normal, distant,non-existent, include a systolic murmur, S3, and/or S4. The controlsystem 1104 and/or a user utilizing the control system determines whatheart sounds and at what rate the sounds are produced in someembodiments. The sounds produced by the heart sound module 1364 aredetectable via use of a stethoscope in some instances. In someembodiments, at least a portion of the heart sound module 1364—such as aspeaker—is positioned within the simulator 1350 where the natural heartwould be.

The patient simulator 1350 also includes lung sound modules 1366, 1368,1370, and 1372. In particular, lung sound module 1366 is utilized tosimulate sounds of the upper right lung towards the front of thesimulator 1350; lung sound module 1368 is utilized to simulate sounds ofthe upper left lung towards the front of the simulator; lung soundmodule 1370 is utilized to simulate sounds of the upper left lungtowards the back of the simulator; lung sound module 1372 is utilized tosimulate sounds of the upper right lung towards the back of thesimulator. Each of the lung sound modules 1366, 1368, 1370, and 1372 isan audio module configured to produce sounds to simulate the naturalsounds of a patient's lungs. In that regard, the lung sound modules1366, 1368, 1370, and 1372 are configured to produce one or more of thefollowing lung sounds in some embodiments: normal, none, wheezing,inspiration squeaks, crackles, rails, and/or other lung sounds. Further,the combination of lung sound modules 1366, 1368, 1370, and 1372 areutilized to simulate respiratory patterns including, but not limited tonormal, Kussmaul's, Cheyne-Stokes, Biot's, apneusic, and/or otherrespiratory patterns. The combination of lung sound modules 1366, 1368,1370, and 1372 are also utilized to simulate the respiratory rate of thepatient. In that regard, the respiratory rate may be set at a constantrate and/or be set to change over time.

The patient simulator 1350 also includes opening module 1374 and closingmodule 1376. The opening and closing modules 1374 and 1376 areconfigured to control the blinking of the patient's simulated eyes. Inparticular, the opening module 1374 is utilized to open the eyelid ofthe simulator and the closing module 1376 is utilized to close theeyelid. Accordingly, with the eyelid open the closing module 1376 isactivated followed by the opening module 1374 being activated tosimulate the patient blinking. The rate, pattern, and speed of blinkingare controlled by the control system 1104 in some instances. In someinstances the rate of blinking ranges from 5 blinks per minute to 30blinks per minute. In other embodiments, ranges outside of this areused. Further, the eyes can be maintained in an open position or aclosed position. The speed of the blinks can be controlled as well. Insome instances, the elapsed time or speed of each blink from open toclosed to open is approximately 200 ms (e.g., approximately 100 ms toclose and approximately 100 ms to reopen). However, the speed of theblinks can be increased or decreased as desired in some embodiments.

The patient simulator 1350 also includes a right lung valve 1378, a leftlung valve 1380, and a breathing valve 1382. Together the right lungvalve 1378, the left lung valve 1380, and the breathing valve 1382control the flow of air into and out of the lungs of the simulator 1350.In that regard, each of the valves 1378, 1380, and 1382 comprise apneumatic valve. In some embodiments, the breathing valve 1382 isutilized to control the respiratory rate of the simulator 1350. In thatregard, the breathing valve 1382 opens and closes in order for the lungsto inflate and deflate at the desired rate. The right lung valve 1378and the left lung valve 1380 are utilized to selectively disable theright and/or left lungs, respectively. Accordingly, in some embodimentswhen the right lung valve 1378 is opened it closes a 3-way air pilotvalve such that air cannot flow from the breathing valve into the rightlung. In such instances, air flows from the breathing valve solely intothe left lung. The left lung valve 1380 operates in a similar manner insome embodiments. Factors such as disablement of the lungs, respiratoryrate, respiratory pattern, inspiratory rate, and/or disablement of theleft or right lung are controlled by the valves 1378, 1380, and 1382based on signals received from the control system 1104 via the mastermodule 1352.

The patient simulator 1350 also includes an ECG module 1384 or rhythmemulator. The ECG module is configured to emit an electrical signal thatsimulates the electrical activity of the heart of the simulator 1350. Insome embodiments, the ECG module is configured to provide signalsassociated with each of the 12 leads such that a 12-lead ECG signal isavailable to the user. In some embodiments, the ECG module 1300 isconfigured to emit signals that simulate the presence of a myocardialinfarction in various parts of the heart. In some embodiments, theposition of the myocardial infarction is selected via the control system1104. Accordingly, the ECG module is utilized to train users to identifythe onset of heart attacks and/or the associated symptoms identifiablevia an ECG. The electrical signal of the ECG module is detectable bystandard ECG equipment.

The patient simulator 1350 also includes a K-sound module 1386 for theleft arm of the simulator and a K-sound module 1388 for the right arm ofthe simulator. Each of the K-sound modules 1386 and 1388 are configuredto produce a simulated K-sound (Korotkoff sound). In that regard, theK-sound modules 1386 and 1388 are utilized to allow a user to take theblood pressure of the patient simulator 1350 in some embodiments.Accordingly, the K-sounds produced by the modules 1386 and 1388 aredetermined based on a simulated heart rate and blood pressure. In someinstances, the heart rate and blood pressure of the patient simulator1350 are provided by a user or teacher via the control system 1104.

The patient simulator also includes a pupil dilation module 1390. Thepupil dilation module 1390 is configured to control the dilation of thepupils of the simulator's eyes. In some embodiments, the pupil dilationof each of the simulator's eyes is controlled at least partially basedon the amount of light received by an optical sensor positioned withinthe eye. Further, the maximum size of the pupil and/or the rate ofchange or dilation of the pupil are controlled by the control system1104 in some instances. In some instances the parameters of the pupildilation are selected to simulate a specific medical condition.

The patient simulator 1350 also includes a compression module 1392. Thecompression module 1392 is configured to monitor the force of chestcompressions applied to the simulator 1350. In that regard, thecompression module 1392 is configured to monitor the pressure appliedand based on that pressure determine whether the pressure is too high,too low, or within the desired range. The compression module 1392 is incommunication with the master module 1352, such that the determinationof whether the correct pressure is being applied is relayed to thecontrol system 1104. In some embodiments, the simulator 1350 will trendtowards recovery or further complications based on whether the correctpressure is applied. For example, if the chest compressions are withinthe desired range of pressures then the patient simulator may show signsof recovery. On the other hand, if the chest compressions are outsidethe desired range of pressures then the patient simulator may developadditional problems or symptoms and/or make it more difficult to recoverthe simulator from the present symptoms.

The patient simulator 1350 also includes a left pedal pulse module 1394and a right pedal pulse module 1396. The left and right pedal pulsemodules 1394, 1396 are configured to simulate the pedal pulses of thesimulator 1350. In that regard, in some embodiments the pedal pulsemodules 1394, 1396 are electrical modules configured to simulate thepedal pulses. In other embodiments, the pedal pulse modules 1394, 1396are pneumatic modules configured to simulate the pedal pulses. Thepatient simulator 1350 also includes a right radial pulse module 1398and a left radial pulse module 1400. The right and left radial pulsemodules 1398, 1400 are pneumatic modules for simulating the radialpulses of the simulator 1350.

The patient simulator 1350 also includes an intubation module 1402. Theintubation module 1402 is configured to monitor intubation of thepatient simulator 1350. In that regard, the depth of proper intubationfor the patient simulator 1350 will depend on the size and/or age of thepatient simulator. Accordingly, in the present embodiment where thesimulator is approximately the size of a five-year old the intubationmodule 1402 is configured to determine the proper intubation depth for afive-year old. In some embodiments, the intubation module 1334 utilizesan optical sensor to monitor the depth of an intubation tube within thetrachea of the patient simulator 1350. In some embodiments, theintubation module 1334 utilizes a pair of optical sensors spaced apartfrom one another to define the acceptable range of intubation depths.The first optical sensor is utilized to detect the presence of anintubation tube as it reaches the beginning of the acceptable range ofdepths. The second optical sensor is utilized to detect when theintubation tube has been advanced beyond the acceptable range of depths.

The patient simulator 1350 also includes a ventilation module 1404. Theventilation module 1404 is configured to monitor the use of aventilation device applied to the simulator 1350. The ventilation deviceis a bag-valve mask in some instances. In other instances, theventilation device is a user's mouth, such as in mouth-to-mouthresuscitation. The ventilation module 1404 is configured to monitor thepressure applied by the ventilation device and based on that pressuredetermine whether the pressure is too high, too low, or within thedesired range. The ventilation module 1404 is in communication with themaster module 1352, such that the determination of whether the correctpressure is being applied is relayed to the control system 1104. In someembodiments, the simulator 1350 will trend towards recovery or furthercomplications based on whether the correct pressure is applied. Forexample, if the ventilation is within the desired range of pressuresthen the patient simulator may show signs of recovery. On the otherhand, if the ventilation is outside the desired range of pressures thenthe patient simulator may develop additional problems or symptoms and/ormake it more difficult to recover the simulator from the presentsymptoms.

The patient simulator 1350 also includes a color change modules 1406.The color change module 1406 is configured for controlling color changearound the lips of the simulator 1350. The color change module 1406 isutilized in some embodiments to simulate cyanosis of the patientsimulator 1350. Accordingly, the color change module 1406 is configuredto simulate different levels of cyanosis of the patient simulator 1350.In that regard, the degree of cyanosis is determined by the controlsystem 1104 and/or a user of the control system 1104 in someembodiments. The degree of cyanosis may trend—increase and/ordecrease—based on a variety of parameters including the efficacy of anytreatments administered. In some embodiments, the trending is controlledmanually via the control system 1104. In other embodiments, the trendingis at least partially controlled by a physiological simulator softwareapplication of the control system 1104.

The patient simulator 1350 also includes a right blood pressure cuffmodule 1408 and a left blood pressure cuff module 1410. The left andright blood pressure cuff modules 1408 and 1410 are pressure modulesconfigured to allow a user to take a simulated blood pressure of thepatient simulator 1350. The blood pressure cuff modules 1408 and 1410are configured for use with standard blood pressure monitors in someembodiments.

In some embodiments, the patient simulator 1350 also includes acompressor module 1412 for controlling a compressor of the simulator1350. Generally, the compressor is utilized to provide a compressed airsupply to the various pneumatic devices and modules of the simulator1350. For example, in some embodiments the compressor is utilized toprovide air to modules for simulating the lungs, pulses, contractions,tummy pressure, seizures, eye dilation, blinking, and/or other aspectsof the patient simulator 1350. In some embodiments, the compressorprovides pressurized air to one or more air reservoirs or accumulatorsthat are then connected to the various pneumatic modules of thesimulator 1350. In that regard, the air reservoirs may maintaindifferent air pressures such that different pneumatic modules areconnected to the air reservoir with the appropriate air pressure for itsapplication. In some instances, the pneumatic modules of the patientsimulator 1350 that utilize the compressor are configured to run at arelatively low air pressure, e.g., less than 10 psi in some embodimentsand less than 5 psi in other embodiments. In some instances, thesimulator 1350 includes two accumulators with one of the accumulatorsmaintaining an air pressure of approximately 5 psi and the otheraccumulator maintaining an air pressure of approximately 1 psi. In otherembodiments, the accumulators maintain other air pressures. Generally,however, the patient simulator 1350 and its associated components areconfigured to operate at low pressures, which helps prevent theintroduction of water into the simulator associated with high pressuresystems. The introduction of water into the simulator that results fromusing high pressure systems can cause damage to the simulator, increasethe maintenance costs, and require additional components to remove orlimit the amount of water within the simulator.

Further, the compressor is sized to fit entirely within the simulator1350 in some embodiments. In that regard, the compressor operatesquietly so as not to interfere with the other simulation aspects of thesimulator 1350 and, in particular, the audible simulation aspects.Accordingly, in some instances a muffler system is utilized to minimizethe noise generated by the compressor. The muffler system is utilized onthe input, output, and/or both sides of the compressor in someembodiments. Further, the compressor is self-cooling in some instances.In one such embodiment, the compressor includes a plurality of metalpipes surrounding at least the compressor motor that intake air ispassed through. The intake air passing through the metal pipes helps todissipate the heat generated by the compressor. Accordingly, thecompressor is able to operate entirely within the simulator 1350 withoutoverheating or disturbing the other simulation aspects of the simulator.This allows the simulator 1350 to be fully functional without attachmentto a noisy, external, high pressure compressor.

Each of the various modules of the simulator 1350 is connected to themaster module 1252 via a power wire, a ground wire, and/or a 2-waycommunication wire. Accordingly, the master module 1252 is utilized tocontrol the activation, deactivation, and power consumption of themodules in some embodiments. In some embodiments, the master module 1252is controlled or directed via a software program of the control system1104. In some embodiments, the master module 1252 is in wirelesscommunication with one or more of the modules. In some embodiments, themodules themselves are interconnected via the communication wire or anadditional communication wire. In that regard, in some instances anon-master module acts as a master module for a subset of modules.

As described above, each of the simulators 1102, 1250, and 1350 comprisea plurality of modules each adapted for performing various functions ofthe simulator. In some embodiments, different modules are similarmodules programmed for different purposes. In that regard, in someinstances the plurality of modules are derived from common set of basemodules. In some instances, the base modules include master modules,interface modules, pneumatic modules, audio modules, sensor modules, anddriver modules. These various base modules are adapted or programmed forthe various specific purposes of the simulators and modules as describedherein. In that regard, it should be noted that modules are created forthe desired or intended functions of the simulators and may includemodules not specifically described herein. These base modules will nowbe described in greater detail.

Referring now to FIG. 32, shown therein is a diagrammatic schematic viewof a master module 1420 for use in a patient simulator according to oneembodiment of the present disclosure. In some instances the mastermodule 1420 is utilized as the master modules 1106, 1252, and/or 1352 ofthe simulators described above. In that regard, the master module 1420is configured to interface with the various modules of the simulatorsand the control system. Specifically, the master module 1420 links thevarious modules together and transfers information and signals betweenthe various modules and between the modules and the control system. Inthat regard, the master module 1420 is configured to receive commandsfrom the control system and relay those commands to the modules. In someinstances communication between the master module 1420 and the controlsystem is accomplished in 100 ms or less such that the commands of thecontrol system are executed in approximately real time and on demand.The master module 1420 is configured to receive information from and/ormonitor the modules and relay that information to the control system. Inthat regard, the master module 1420 monitors and/or reads some of thesensor modules constantly. The frequency of the monitoring and/orreading is determined by the specific function being monitored. Some ofthe modules are monitored many times per second, while other modules aremonitored less frequently. Monitoring the modules includes obtainingsensor data from the modules (e.g., amount of compression orventilation) as well as general information regarding the module (e.g.,on/off, connected or not connected, etc.). The general informationincluding the status and/or the presence of modules within the simulatoris available to the user via the control system in some embodiments. Inthat regard, modules of the simulator are activated and deactivated viathe control system in some instances.

As shown in FIG. 32, the master module 1420 includes an input 1422. Theinput 1422 includes a power supply input 1424 and a ground 1426. In someembodiments, the power supply input 1424 is configured to receive powerfrom a battery located within the simulator. Accordingly, the powersupply input 1424 is configured to receive direct current power in suchembodiments. In other embodiments, the power supply input 1424 isconfigured to receive alternating current power, such as from a walloutlet. The master module 1420 also includes a low voltage regulator1428 that regulates the power received from the power supply input 1424.The master module 1420 also includes an output 1430. The output 1430 isutilized to connect the master module 1420 to the other modules of thesimulator. As discussed above the connection between the master module1420 and the other modules includes a power supply, a ground, and a2-way communication cable. Accordingly, the output 1430 includes a poweroutput 1432, a ground 1434, and a communication output 1436. The mastermodule 1420 also includes a processor 1438 for processing the variousinformation requests, data transfers, and other functions performed bythe master module. Finally, the master module 1420 includes acommunication device 1440. In the current embodiment, the communicationdevice 1440 comprises an RF module. In other embodiments, thecommunication device 1440 may be any other type of communication modulethat facilitates communication with the control system including bothwireless and wired communication systems.

Referring now to FIG. 33, shown therein is a diagrammatic schematic viewof a communication module 1450 for use in a patient simulator systemaccording to one embodiment of the present disclosure. The communicationmodule 1450 is configured to communicate with the communication device1440 of the master module 1420 in some embodiments. In that regard, thecommunication device 1440 is configured for use as a part of or a linkto the control system. In the current embodiment, the communicationdevice 1440 includes an RF module 1452 for communicating the RF moduleof the master module 1420. The communication device 1440 also includes aprocessor 1454 and an output 1456. In some embodiments, the processor1454 is configured to convert the signals received via RF module 1452into an output form for transmission out the output 1456. In the presentembodiment, the output 1456 is a USB connector that is or may beconnected to a computer system of the control system.

Referring now to FIG. 34, shown therein is a diagrammatic schematic viewof a communication module 1460 for use in a patient simulator systemaccording to another embodiment of the present disclosure. Thecommunication module 1460 is configured to communicate with a mastermodule 1462 of the simulator in some embodiments. In that regard, thecommunication device 1460 is configured for use as a part of or a linkto a control system. In the current embodiment, the communication device1460 is hard wired to the master module 1462 via lines 1464, 1466, and1468. In the present embodiment, the communication module 1460 providesa USB output connector that is or may be connected to a computer systemof the control system.

Referring now to FIG. 35, shown therein is a diagrammatic schematic viewof a pneumatic module 1470 for use in a patient simulator systemaccording to one embodiment of the present disclosure. The pneumaticmodule 1470 includes an input 1472. The input 1472 is configured toconnect the pneumatic module 1470 to a master module, such as mastermodule 1420. In that regard, the input 1472 includes a power input 1474,a ground 1476, and a communication input 1478. Accordingly, the input1472 is in communication with the output 1430 of the master module 1420.The communication input 1478 also serves as a communication output for2-way communication between the pneumatic module 1470 and the mastermodule 1420. The pneumatic module 1470 also includes a voltage regulator1480 and a processor 1482. The processor 1482 is programmed differentlydepending on the particular function of the pneumatic module 1470. Forexample, in some instances the pneumatic module 1470 is programmed toserve as a breathing valve module, lung valve module, larynges module,pharynges module, pneumothorax module, pneumothorax release module,tongue module, arm motion module, baby release module, eye blinkingmodule, eye closing module, pupil dilation module, seizure module, pulsemodule, color change module, tummy valve module, and/or other modulesfor use in a simulator. Depending on the programming of the processor1482 and the signals received from the master module 1420, an output1484 of the pneumatic module 1470 causes an associated valve to eitherbe opened or closed.

Referring now to FIG. 36, shown therein is a diagrammatic schematic viewof an audio module 1490 for use in a patient simulator according to oneembodiment of the present disclosure. The audio module 1490 includes aninput 1492. The input 1492 is configured to connect the audio module1490 to a master module, such as master module 1420. In that regard, theinput 1492 includes a power input 1494, a ground 1496, and acommunication input 1498. Accordingly, the input 1492 is incommunication with the output 1430 of the master module 1420. Thecommunication input 1498 also serves as a communication output for 2-waycommunication between the audio module 1490 and the master module 1420in some embodiments. The audio module 1490 includes a voltage regulator1500 and a voltage regulator 1502. The voltage regulator 1502 isconfigured to provide power to an amplifier 1504, which drives an audiooutput or speaker 1506. The audio module 1490 also includes an audiochip 1508 and a processor 1510. The audio chip 1508 and/or the processor1510 are programmed differently depending on the particular function ofthe audio module 1490. For example, in some instances the audio module1490 is configured to serve as a lung sound module, heart sound module,K-sound module, voice module, womb sound module, and/or other soundmodules for use in a simulator. The audio chip 1508 and/or the processor1510 are configured for the particular function of the audio module1490. In some embodiments, the audio module 1490 includes memoryassociated with the audio chip 1508 or the processor 1510 that includesa plurality of prerecorded sounds thereon. The audio module 1470selectively plays the prerecorded sounds in such embodiments. In someembodiments, the playing of the prerecorded sounds is determined atleast in part by signals received from the control system via the mastermodule 1420.

Referring now to FIG. 37, shown therein is a diagrammatic schematic viewof a sensing module 1520 for use in a patient simulator according to oneembodiment of the present disclosure. The sensing module 1520 includesan input 1522. The input 1522 is configured to connect the sensingmodule 1520 to a master module, such as master module 1420. In thatregard, the input 1522 includes a power input 1524, a ground 1526, and acommunication input 1528. Accordingly, the input 1522 is incommunication with the output 1430 of the master module 1420. Thecommunication input 1528 also serves as a communication output for 2-waycommunication between the sensing module 1520 and the master module 1420in some embodiments. The sensing module 1520 includes a voltageregulator 1530 and a processor 1532. In some instances the voltageregulator 1530 is configured to provide power to an amplifier 1534. Theamplifier 1534 is used in some embodiments to amplify the signalreceived from a sensor 1536. In other embodiments, the amplifier 1534 isused to drive the sensor 1536. The sensor 1536 is used to monitor aparameter associated with the various functions of the simulator.Accordingly, in some embodiments the sensor 1536 is a force sensor, loadsensor, position sensor, optical sensor, temperature sensor, pH sensor,and/or other sensor for use in the simulator. In that regard, theamplifier 1534 and/or the processor 1532 are programmed differentlydepending on the particular function of the sensing module 1520. Forexample, in some instances the sensing module 1520 is configured toserve as a breathing valve module, blood pressure module, compressormodule, ventilation module, compression module, load cell module, pulsemodule, other sensing module, and/or part thereof for use in asimulator.

Referring now to FIG. 38, shown therein is a diagrammatic schematic viewof a sensing driver module 1521 for use in a patient simulator accordingto one embodiment of the present disclosure. In some aspects the sensingdriver module 1521 is similar to the sensing module 1520 described abovewith respect to FIG. 37. However, in addition to the sensing aspects ofthe sensing module 1520, the sensing driver module 1521 includes adriver 1538. In that regard, the sensing driver module 1521 isconfigured to drive or actuate a device based on the sensed parametersof the module. For example, in the current embodiment the driver 1538 isconfigured to drive a compressor of the simulator. In that regard thesensing driver module 1521 may be utilized to maintain a desired airpressure within a reservoir supplied by the compressor. Accordingly, thesensor 1536 is utilized to monitor the pressure within the reservoir andthen based on the sensed pressure the driver 1538 can be activated toadjust the pressure in the reservoir to the desired pressure. In thatregard, the driver 1538 includes a first output 1540 for activating thecompressor to increase the pressure and a second output 1542 forreducing the pressure. In other embodiments, the driver 1538 drivesdevices other than a compressor, including mechanical actuators,pneumatic actuators, electrical actuators, and/or other components ofthe simulator. In that regard, the sensing driver module 1520 isconfigured to serve as a breathing valve module, blood pressure module,compressor module, ventilation module, compression module, load cellmodule, pulse module, other sensing driver module, and/or part thereoffor use in a simulator.

Referring now to FIG. 39, shown therein is a diagrammatic schematic viewof an ECG module 1550 for use in a patient simulator according to oneembodiment of the present disclosure. The ECG module 1550 includes aninput 1552. The input 1552 is configured to connect the ECG module 1550to a master module, such as master module 1420. In that regard, theinput 1552 includes a power input 1554, a ground 1556, and acommunication input 1558. Accordingly, the input 1552 is incommunication with the output 1430 of the master module 1420. Thecommunication input 1558 also serves as a communication output for 2-waycommunication between the ECG module 1550 and the master module 1420 insome embodiments. The ECG module 1550 includes a voltage regulator 1560and a processor 1562. The ECG module 1550 is configured to emitelectrical signals that simulate the electrical activity of the heart ofthe simulator. In some embodiments, the ECG module is configured toprovide signals associated with each of the 12 leads such that a 12-leadECG signal is provided by the simulator. In some embodiments, the ECGmodule is configured to emit signals that simulate the presence of amyocardial infarction in various parts of the heart. In someembodiments, the position of the myocardial infarction is selected viathe control system. The processor 1562 is programmed to execute each ofthe desired ECG simulations. The ECG module is utilized to train usersto identify the onset of heart attacks and/or the associated symptomsidentifiable via an ECG. The electrical signal of the ECG module isdetectable by standard ECG equipment. In some embodiments the electricalsignal of the ECG module is an analog signal. The ECG module 1550 alsoincludes an input/output connector 1564. The input/output connector 1564connects the ECG module 1550 to a pacer/defib module, such aspacer/defib module 1580 described with respect to FIG. 40 below.Generally, the input/output connector 1564 is configured to receivepacer info 1566 and defib info 1568 from the pacer/defib module 1580 andoutput ECG data or signals 1570 to the pacer/defib module.

Referring now to FIG. 40, shown therein is a diagrammatic schematic viewof a Pacer/Defib module 1580 for use in a patient simulator according toone embodiment of the present disclosure. The pacer/defib module 1580 isconfigured to allow external pacing and defibrillation from the samelocation. The pacer/defib module 1580 includes an input/output connector1582. The input/output connector 1564 is configured to send pacer info1566 and defib info 1568 to the ECG module 1550 and receive ECG data orsignals 1570 from the ECG module. The pacer/defib module 1580 isconfigured to simulate the natural resistance of patient. To that end,the pacer/defib module 1580 includes a resistor 1584 sized to simulatethe resistance of the patient. In that regard, the resistance of theresistor 1584 may vary depending on the size, age, and/or othercharacteristics of the simulator. The pacer/defib module 1580 alsoincludes circuitry 1586 for conditioning the analog signal created bythe pacer/defib module 1580.

Referring now to FIG. 41, shown therein is a diagrammatic schematic viewof a motor driver module 1590 for use in a patient simulator systemaccording to one embodiment of the present disclosure. The motor drivermodule 1590 includes an input 1592. The input 1592 is configured toconnect the motor driver module 1590 to a master module, such as mastermodule 1420. In that regard, the input 1592 includes a power input 1594,a ground 1596, and a communication input 1598. Accordingly, the input1592 is in communication with the output 1430 of the master module 1420.The communication input 1598 also serves as a communication output for2-way communication between the motor driver module 1590 and the mastermodule 1420 in some embodiments. The motor driver module 1590 includes avoltage regulator 1600 and a processor 1602. The processor 1602 isprogrammed to control drivers 1604 and 1606. The drivers 1604 and 1606are configured to actuate a motor. In that regard, the drivers 1604 and1606 are configured to drive motors for use in translation, rotation,and vibrations. Accordingly, in some embodiments the motor driver module1590 is configured for use as a delivery module, a rotation module, aseizure module, a vibration module, and/or other module associated witha motor of the simulator.

Referring now to FIG. 42, shown therein is a diagrammatic schematic viewof an intubation module 1610 for use in a patient simulator systemaccording to one embodiment of the present disclosure. The intubationmodule 1610 includes an input 1612. The input 1612 is configured toconnect the intubation module 1610 to a master module, such as mastermodule 1420. In that regard, the input 1612 includes a power input 1614,a ground 1616, and a communication input 1618. Accordingly, the input1612 is in communication with the output 1430 of the master module 1420.The communication input 1618 also serves as a communication output for2-way communication between the intubation module 1610 and the mastermodule 1420 in some embodiments. The intubation module 1610 includes avoltage regulator 1620 and a processor 1622. The intubation module 1610is configured to monitor intubation of the patient simulator. In thatregard, the depth of proper intubation for the patient simulator willdepend on the size and/or age of the patient simulator. Accordingly, inthe current embodiment the intubation module 1610 includes a first pairof optical sensors 1624 and 1626 for monitoring intubation in a baby anda second pair of optical sensors 1628 and 1630 for monitoring intubationin an adult. In other embodiments, other ages of simulator are accountedfor. Only one pair of optical sensors is activated. The activated pairis chosen based on the size of the simulator in which the intubationmodule 1610 is being utilized. In other embodiments, the intubationmodule 1610 includes only a single pair of optical sensors spacedappropriately for the size and/or age of the patient simulator. Theintubation module 1610 utilizes the optical sensors to monitor the depthof an intubation tube within the trachea of the patient simulator. Inthat regard, the optical sensors 1624 and 1628 are utilized to detectthe presence of an intubation tube as it reaches the beginning orminimum of the acceptable range of depths. The optical sensors 1626 and1630 are utilized to detect when the intubation tube has been advancedbeyond the maximum acceptable range of intubation depths.

Referring now to FIG. 43, shown therein is a diagrammatic schematic viewof an inflation/deflation module 1640 for use in a patient simulatoraccording to one embodiment of the present disclosure. In someembodiments the inflation/deflation module 1640 is utilized to simulatea pregnant mother's tummy. The inflation/deflation module 1640 includesan input 1642. The input 1642 is configured to connect theinflation/deflation module 1640 to a master module, such as mastermodule 1420. In that regard, the input 1642 includes a power input 1644,a ground 1646, and a communication input 1648. Accordingly, the input1642 is in communication with the output 1430 of the master module 1420.The communication input 1648 also serves as a communication output for2-way communication between the inflation/deflation module 1640 and themaster module 1420 in some embodiments. The inflation/deflation module1640 includes a pressure sensing module 1650, an inflation module 1652,and a deflation module 1654. The inflation and deflation modules 1652and 1654 comprise pneumatic valves in some embodiments. Theinflation/deflation module 1640 is configured to monitor the pressurewithin a reservoir of the simulator using the pressure sensing module1650 and then adjust the pressure to the desired pressure using theinflation and deflation modules 1652 and 1654.

Referring now to FIG. 44, shown therein is a diagrammatic schematic viewof a patient simulator system 1700 according to one embodiment of thepresent disclosure. The patient simulator system 1700 includes a patientsimulator 1702 and a control system 1104. The control system 1104 may besubstantially similar to the control system described above with respectto FIG. 29. The patient simulator 1702 includes a plurality of modulesfor performing the various functions of the simulator. In someembodiments, each of the modules controls a particular function or groupof functions of the simulator 1702. In that regard, the modules areappropriately sized for positioning within various portions of thesimulator 1702. In some embodiments, the modules are positionedthroughout the simulator adjacent to the region or area of the simulator1702 related to the module's specific function or the associated bodypart of the simulator. Accordingly, the modules are distributedthroughout the simulator rather than being grouped onto a singlemotherboard. In some embodiments, each of the modules is incommunication with a master module 1706. In some embodiments the mastermodule 1706 is configured to provide and control the power delivered tothe modules and facilitate communication with and among the modules.

In the current embodiment, the patient simulator 1702 is in wirelesscommunication with the control system 1104. In that regard, the patientsimulator 1702 includes a wireless communication module 1708 and anantenna 1710. The wireless communication module 1708 and antenna 1710are in communication with an antenna 1112 and a wireless communicationmodule 1114 of the control system 1104. In the current embodiment thewireless communication module 1114 is connected to or in communicationwith a computer system 1116. In that regard, the computer system 1116 isa laptop or tablet PC in some instances. Generally, the computer system1116, or the control system 1104 as a whole, is any combination ofhardware and software capable of controlling or defining various factorsand/or functions of the patient simulator 1702 through the master module1706.

According to the present disclosure, various modules may be combined tocreate a simulator with specific features as desired by a customer oruser. In this manner, some or all of the modules included in the patientsimulator 1702 may be selected based on the intended use of thesimulator. The modular nature of the modules allows the simulator 1702to include the combination features that a customer desires initially,but also allows a customer to add additional features or disableincluded features later. One specific combination of available modulesfor use in the simulator 1702 will now be described. However, nolimitation is intended thereby. In that regard, it is understood thatsimulators according to the present disclosure may include additional,fewer, or other combinations of modules. Various combinations of themodules are particularly suited for use in different types of patientsimulators. Accordingly, in some embodiments a patient simulator systemis created by combining modules having the desired features of thecompleted simulator. In some instances, the modules are configured forplug-n-play with the master module 1706 of the simulator 1702 such thatmodules may be added or removed as desired. Similarly, in someembodiments the control system 1104 is configured to activate ordeactivate modules within the simulator 1702 as desired by a user. Insome embodiments, the control system 1104 is configured to provide dataregarding the modules present in the simulator, the modules availablefor use with the simulator but not present in the simulator, and/or thestatus (activated or not) of present modules.

The patient simulator 1702 includes a voice module 1724. The voicemodule 1724 is in communication with the master module 1706, which is incommunication with the control system 1104. The voice module 1724 is anaudio module configured to emit sounds simulating a patient's voice. Inthat regard, the particular sounds emitted by the voice module 1724 arecontrolled in some embodiments by a user through the control system1104. In some embodiments, the control system 1104 includes a pluralityof stored or prerecorded sounds that may be selected from and playedback by the voice module 1724.

In some embodiments, the sounds include one or more of various answersto questions medical personnel might ask a patient and/or sounds apatient might make. For example, the answers may include variouscomplaints (e.g., “ankle broken”, “arm broken”, “blood in toilet”,“can't catch breath”, “can't move”, “can't move legs”, “chest hurts”,“coughing up blood”, “elephant on chest”, “feel dizzy”, “feel nauseous”,“feel weak”, “heart beating fast”, “heart pounding”, “heart trying tojump”, “hurt all over”, “hurts when breathing”, “I′ ve been cut”, “jawhurts”, “left arm hurts”, “leg is broken”, “passing blood”, “peeingblood”, “pooping blood”, “puking blood”, “short of breath”, “shoulderhurts”, “somebody shot me”, “stomach hurts”, “worst headache”, and/orother complaints), confused answers (e.g., “Are you a doctor?”, “I don'tremember”, “What happened?”, “Who are you?”, and/or other confusedanswers), location answers (e.g., “in my arm”, “in my chest”, “in myleg”, “in my shoulder”, “left side”, “right side”, and/or other locationanswers), descriptive answers (e.g., “a little bit”, “a lot”, “I can'tmove it”, “it's dull”, “it's sharp”, “not pain . . . pressure”, “pain incenter chest”, “sharp tearing pain”, and/or other descriptive answers),evasive answers (e.g., “I feel fine”, “take me to a hospital”, and/orother evasive answers), generic answers (e.g., “yes”, “no”, “maybe”,and/or other generic answers), history answers (e.g., “asthma”,“diabetes”, “emphysema”, “had heart attack”, “high blood pressure”,and/or other history answers), occurrence answers (e.g., “once”,“twice”, “three times”, “four times”, “since last night”, “since thismorning”, “since this afternoon”, and/or other occurrence answers). Inaddition to the answers and responses noted above, the sounds includecoughing, gagging, choking, moaning, screaming, and/or other sounds apatient makes. In that regard, each of the sounds may have differentlevels or types. For example, in some instances the sounds includedifferent severity of coughs, gags, moaning, screaming, and/or othersounds.

In some embodiments, the control system 1104 is in communication withthe voice module 1724 such that a user or teacher speaks into amicrophone or other sound communication device associated with thecontrol system and the teacher's words or sounds are emitted from thevoice module 1724. In some embodiments, the user or teacher's input maybe conditioned using audio amplifiers or sound boards to alter the soundof the voice emitted from the voice module 1724. For example, in someembodiments the input sound is conditioned to simulate a hoarse patient,a patient with a blocked air passage, or other mental or physicalmedical condition of the patient. In that regard, the teacher mayselectively activate various types of audio conditioning based on adesired effect. The voice module 1724 and the corresponding voicesimulation are utilized as part of an overall medical scenariosimulation in some embodiments.

The patient simulator 1702 also includes a delivery motor module 1726.The delivery motor module 1726 is utilized to control the delivery ofthe fetus or baby from the simulator 1702 in embodiments where thesimulator is a birthing simulator. In that regard, the delivery motormodule 1726 is utilized to control the position of the baby within themother simulator. Upon activation by the delivery motor module 1726, thedelivery mechanism urges the baby out of the mother's womb. In someembodiments, the delivery mechanism will deliver the baby at leastpartially out of the mother's womb where the user completes delivery ofthe baby. In some embodiments, the delivery mechanism rotates the babyas it travels down the birth canal. Generally, the delivery motor module1726 is configured to translate the baby along the birth canal. In thatregard, the number of turns of the motor relative to a starting point isutilized to determine the precise translational position of the babywithin the maternal simulator in some instances.

The patient simulator 1702 also includes a womb audio module 1728 tosimulate the sounds of the fetus within the womb of the mother. Forexample, in some embodiments the womb audio module 1728 is an audiomodule configured to simulate the heart beat of the fetus within thewomb. In that regard, the audio module produces a fetal heart sound aswould be heard by someone using an ordinary stethoscope placed onto themother's abdomen in an effort to hear the fetus's heart rate. In someembodiments, the fetal heart rate and its rates of change aresynchronized with maternal contractions during a simulation. The phasingof changes in heart rate and contractions is used to assess thecondition of the fetus in utero. Such phasing produces patterns that areevaluated to assess the condition of the fetus. The phasing patternsinclude periodic accelerations, late decelerations, and/or variabledecelerations for example. In some embodiments, at a speaker of the wombaudio module 1728 is located within the fetus and responds to commandsfrom the Instructor through the master module 1706 located in maternalsimulator. In some embodiments, the power and logic for the module 1728are positioned adjacent the connection between the fetus and thebirthing mechanism.

The patient simulator 1702 also includes a breathing valve 1730, a rightlung valve 1732, and a left lung valve 1734. Together the breathingvalve 1730, right lung valve 1732, and the left lung valve 1734 controlthe flow of air into and out of the lungs of the simulator 1702. In thatregard, each of the valves 1730, 1732, and 1734 comprise a pneumaticvalve. In some embodiments, the breathing valve 1730 is utilized tocontrol the respiratory rate of the simulator 1702. In that regard, thebreathing valve 1730 opens and closes in order for the lungs to inflateand deflate at the desired rate. The right lung valve 1732 and the leftlung valve 1734 are utilized to selectively disable the right and/orleft lungs, respectively. Accordingly, in some embodiments when theright lung valve is opened it closes a 3-way air pilot valve such thatair cannot flow from the breathing valve into the right lung. In suchinstances, air flows from the breathing valve solely into the left lung.Factors such as disablement of the lungs, respiratory rate, respiratorypattern, inspiratory rate, and/or disablement of the left or right lungis controlled by the valves 1730, 1732, and 1734 based on signalsreceived from the control system 1104 via the master module 1706.

The patient simulator 1702 also includes an ECG module 1736. The ECGmodule 1736 is configured to emit an electrical signal that simulatesthe electrical activity of the heart of the simulator 1702. In someembodiments, the ECG module 1736 is configured to provide signalsassociated with each of the 12 leads such that a 12-lead ECG signal isavailable to the user. In some embodiments, the ECG module 1736 isconfigured to emit signals that simulate the presence of a myocardialinfarction in various parts of the heart. In some embodiments, theposition of the myocardial infarction is selected via the control system1104. Accordingly, the ECG module is utilized to train users to identifythe onset of heart attacks and/or the associated symptoms identifiablevia an ECG. The electrical signal of the ECG module is detectable bystandard ECG equipment. Further, in some embodiments the ECG module 1736is utilized in combination with a pacer/defib module. For example, insome instances the ECG module 1736 is used in combination with apacer/defib module such as that described with respect to FIG. 40 above.

The patient simulator 1702 also includes a ventilation module 1738. Theventilation module 1738 is configured to monitor the use of aventilation device applied to the simulator 1738. The ventilation deviceis a bag-valve mask in some instances. In other instances, theventilation device is a user's mouth, such as in mouth-to-mouthresuscitation. The ventilation module 1738 is configured to monitor thepressure applied by the ventilation device and based on that pressuredetermine whether the pressure is too high, too low, or within thedesired range. The ventilation module 1738 is in communication with themaster module 1706, such that the determination of whether the correctpressure is being applied is relayed to the control system 1104. In someembodiments, the simulator 1702 will trend towards recovery or furthercomplications based on whether the correct pressure is applied. Forexample, if the ventilation is within the desired range of pressuresthen the patient simulator may show signs of recovery. On the otherhand, if the ventilation is outside the desired range of pressures thenthe patient simulator may develop additional problems or symptoms and/ormake it more difficult to recover the simulator from the presentsymptoms.

The patient simulator 1702 also includes a heart sound module 1740. Theheart sound module 1740 is an audio module configured to emit sounds tosimulate the natural sounds of a patient's heart. In that regard, thesounds of the heart sound module 1740 include one or more of sounds tosimulate the patient's heart rate and cardiac rhythm (e.g., sinus,atrial tachycardia, multifocal atrial tachycardia, atrial flutter,atrial fibrillation, junctional, idioventricular, ventriculartachycardia (uni.), ventricular tachycardia (multi.), supraventriculartachycardia, ventricular flutter, ventricular fibrillation, agonal,asystole, LBBB, RBBB, 1^(st) degree AVB, 2^(nd) degree AVB (Type I),2^(nd) degree AVB (Type II), 3^(rd) degree AVB, Q-wave infarction, STsegment elevation, ST segment depression, T-wave inversion, atrialpaced, AV sequential paced, vent. Pacemaker (artificial), and/or othercardiac rhythms). Further, the heart sounds may be normal, distant,non-existent, include a systolic murmur, S3, and/or S4. The controlsystem 1104 and/or a user utilizing the control system determines whatheart sounds and at what rate the sounds are produced in someembodiments. The sounds produced by the heart sound module 1740 aredetectable via use of a stethoscope in some instances. In someembodiments, at least a portion of the heart sound module 1740—such as aspeaker—is positioned within the simulator 1102 where the natural heartwould be.

The patient simulator 1702 also includes a femoral pulse module 1742.The femoral pulse module 1742 is a pneumatic module for simulating thefemoral pulse of the simulator 1702. The patient simulator 1702 alsoincludes a right pedal pulse module 1744 and a left pedal pulse module1746. The left and right pedal pulse modules 1744, 1746 are configuredto simulate the pedal pulses in the feet of the simulator 1702. In thatregard, in some embodiments the pedal pulse modules 1744, 1746 areelectrical modules configured to simulate the pedal pulses. In otherembodiments, the pedal pulse modules 1744, 1746 are pneumatic modulesconfigured to simulate the pedal pulses. The patient simulator 1702 alsoincludes a right radial pulse module 1748 and a left radial pulse module1750. The right and left radial pulse modules 1748, 1750 are pneumaticmodules for simulating the radial pulses of the simulator 1702. Thepatient simulator 1702 also includes a bilateral pulse module 1752 forsimulating the bilateral pulse of the simulator. The patient simulator1702 also includes an umbilical pulse module 1754 for simulating theumbilical pulse between a maternal simulator and associate fetalsimulator.

The patient simulator 1702 also includes a compression module 1756. Thecompression module 1756 is configured to monitor the force of chestcompressions applied to the simulator 1702. In that regard, thecompression module 1756 is configured to monitor the pressure appliedand based on that pressure determine whether the pressure is too high,too low, or within the desired range. The compression module 1756 is incommunication with the master module 1706, such that the determinationof whether the correct pressure is being applied is relayed to thecontrol system 1704. In some embodiments, the simulator 1702 will trendtowards recovery or further complications based on whether the correctpressure is applied. For example, if the chest compressions are withinthe desired range of pressures then the patient simulator may show signsof recovery. On the other hand, if the chest compressions are outsidethe desired range of pressures then the patient simulator may developadditional problems or symptoms and/or make it more difficult to recoverthe simulator from the present symptoms.

The patient simulator 1702 also includes a right amputation arm module1758 and a left amputation arm module 1830. The amputation arm modules1758 and 1830 are configured to work with an arm that simulates asevered arm, as might be seen in a war zone or car accident. In otherembodiments, the patient simulator 1702 includes similar amputationmodules for use with severed legs. The amputation modules 1758 and 1830are configured to spurt simulated blood as a function of the selectedheart rate and blood pressure of the simulator 1702. The arm of thesimulator 1702 contains a bladder that is filled with the simulatedblood. The amputation modules 1758 and 1830 include connections forpneumatic pressure and electrical power. The power selectively activatesa pneumatic valve to start/stop bleeding as a function of thesimulator's heart rate. The strength or amount of the arterial spurtingis controlled by selecting the length of the time the valve is openand/or by selecting the pressure in the line connected to the bladder.The longer the valve is open and the greater the pressure, the moreblood will spurt from the arm. The bleeding can be stopped by theapplication of a conventional tourniquet to severed arm. In someembodiments, a flexible tube is positioned under the skin of thesimulator in the area where a tourniquet should be placed. If a userproperly places the tourniquet then the flexible tube will be closed andthe bleeding stops. However, if the tourniquet is not properlypositioned or positioned property but without sufficient tension toclose the tube, then the simulator 1702 continues to bleed.

The patient simulator 1702 also includes lung sound modules 1760, 1762,1764, 1766, 1768, 1770, 1772, and 1774. In particular, lung sound module1760 is utilized to simulate sounds of the upper right lung towards thefront of the simulator 1702; lung sound module 1762 is utilized tosimulate sounds of the upper left lung towards the front of thesimulator; lung sound module 1764 is utilized to simulate sounds of thelower right lung towards the front of the simulator; lung sound module1766 is utilized to simulate sounds of the lower left lung towards thefront of the simulator; lung sound module 1768 is utilized to simulatesounds of the upper right lung towards the back of the simulator; lungsound module 1770 is utilized to simulate sounds of the upper left lungtowards the back of the simulator; lung sound module 1772 is utilized tosimulate sounds of the lower right lung towards the back of thesimulator; lung sound module 1774 is utilized to simulate sounds of thelower left lung towards the front of the simulator.

Each of the lung sound modules 1760, 1762, 1764, 1766, 1768, 1770, 1772,and 1774 is an audio module configured to produce sounds to simulate thenatural sounds of a patient's lungs. In that regard, the lung soundmodules 1760, 1762, 1764, 1766, 1768, 1770, 1772, and 1774 areconfigured to produce one or more of the following lung sounds in someembodiments: normal, none, wheezing, inspiration squeaks, crackles,rails, and/or other lung sounds. Further, the combination of lung soundmodules 1760, 1762, 1764, 1766, 1768, 1770, 1772, and 1774 are utilizedto simulate respiratory patterns including, but not limited to normal,Kussmaul's, Cheyne-Stokes, Biot's, apneusic, and/or other respiratorypatterns. The combination of lung sound modules 1760, 1762, 1764, 1766,1768, 1770, 1772, and 1774 are also utilized to simulate the respiratoryrate of the patient. In that regard, the respiratory rate may be set ata constant rate and/or be set to change over time.

The patient simulator 1102 also includes a K-sound module 1776 for theright arm of the simulator and a K-sound module 1778 for the left arm ofthe simulator. Each of the K-sound modules 1776 and 1778 are configuredto produce a simulated K-sound (Korotkoff sound). In that regard, theK-sound modules 1776 and 1778 are utilized to allow a user to take theblood pressure of the patient simulator 1702 in some embodiments. Inthat regard, the K-sound modules 1776 and 1778 are configured to producethe associated K-sounds when a user is taking the blood pressure of thesimulator 1702. In some embodiments, the determination of what K-soundsare to be produced is at least partially determined by the pressuremeasurements of a blood pressure cuff module of the simulator 1702.Further, the K-sounds produced by the modules 1776 and 1778 aredetermined based on a simulated heart rate and blood pressure. In someinstances, the heart rate and blood pressure of the patient simulator1702 are provided by a user or teacher via the control system 1104.

The patient simulator 1702 also includes a left blood pressure cuffmodule 1780 and a right blood pressure cuff module 1782. The left andright blood pressure cuff modules 1780 and 1782 are pressure modulesconfigured to allow a user to take a simulated blood pressure of thepatient simulator 1702. The blood pressure cuff modules 1780 and 1782are configured for use with standard blood pressure monitors in someembodiments.

The patient simulator 1702 also includes a compressor module 1784. Thecompressor module 1784 is configured to control a compressor of thesimulator 1702. The compressor is utilized to provide a compressed airsupply to the various pneumatic devices of the simulator 1702. Forexample, in some embodiments the compressor is utilized to provide airto modules for simulating the lungs, pulses, contractions, tummypressure, seizures, eye dilation, blinking, and/or other aspects of thepatient simulator 1702. In some embodiments, the compressor providespressurized air to one or more air reservoirs or accumulators that arethen connected to the various pneumatic modules of the simulator 1702.In that regard, the air reservoirs may maintain different air pressuressuch that different pneumatic modules are connected to the air reservoirwith the appropriate air pressure for its application. In someinstances, the pneumatic modules of the patient simulator 1702 thatutilize the compressor are configured to run at a relatively low airpressure, e.g., less than 10 psi in some embodiments and less than 5 psiin other embodiments. In some instances, the simulator 1702 includes twoaccumulators with one of the accumulators maintaining an air pressure ofapproximately 5 psi and the other accumulator maintaining an airpressure of approximately 1 psi. In other embodiments, the accumulatorsmaintain other air pressures. Generally, however, the patient simulator1702 and its associated components are configured to operate at lowpressures, which helps prevent the introduction of water into thesimulator associated with high pressure systems. The introduction ofwater into the simulator that results from using high pressure systemscan cause damage to the simulator, increase the maintenance costs, andrequire additional components to remove or limit the amount of waterwithin the simulator.

Further, the compressor is sized to fit entirely within the simulator1702. In that regard, the compressor operates quietly so as not tointerfere with the other simulation aspects of the simulator 1702.Accordingly, in some instances a muffler system is utilized to minimizethe noise generated by the compressor. The muffler system is utilized onthe input, output, and/or both sides of the compressor in someembodiments. Further, the compressor is self-cooling in some instances.In one such embodiment, the compressor includes a plurality of metalpipes surrounding at least the compressor motor that intake air ispassed through. The intake air passing through the metal pipes helps todissipate the heat generated by the compressor. Accordingly, thecompressor is able to operate entirely within the simulator 1702 withoutoverheating or disturbing the other simulation aspects of the simulator.This allows the simulator 1702 to be fully functional without attachmentto a noisy, external, high pressure compressor.

The patient simulator 1702 also includes a plurality of color changemodules 1786, 1788, and 1790. In that regard, the color change module1786 is configured for controlling color change around the lips of thesimulator 1702; the color change module 1788 is configured forcontrolling color change around the fingers of the simulator; and thecolor change module 1790 is configured for controlling color changearound the toes of the simulator. The color change modules 1786, 1788,and 1790 are utilized in some embodiments to simulate cyanosis of thepatient simulator. Accordingly, the color change modules 1786, 1788, and1790 are configured to simulate different levels of cyanosis of thepatient simulator 1702. In that regard, the degree of cyanosis isdetermined by the control system 1104 and/or a user of the controlsystem 1104 in some embodiments. The degree of cyanosis maytrend—increase and/or decrease—based on a variety of parametersincluding the efficacy of any treatments administered. In someembodiments, the trending is controlled manually via the control system1104. In other embodiments, the trending is at least partiallycontrolled by a physiological simulator software application of thecontrol system 1104.

The patient simulator 1702 also includes an intubation module 1792. Theintubation module 1792 is configured to monitor intubation of thepatient simulator 1702. In that regard, the depth of proper intubationfor the patient simulator 1702 will depend on the size and/or age of thepatient simulator. In that regard, the intubation module 1792 isassociated with a particular size of patient simulator to determine theproper intubation depth. In some embodiments, the intubation module 1792utilizes an optical sensor to monitor the depth of an intubation tubewithin the trachea of the patient simulator 1702. In some embodiments,the intubation module 1792 utilizes a pair of optical sensors spacedapart from one another to define the acceptable range of intubationdepths. The first optical sensor is utilized to detect the presence ofan intubation tube as it reaches the beginning of the acceptable rangeof depths. The second optical sensor is utilized to detect when theintubation tube has been advanced beyond the acceptable range of depths.

The patient simulator 1702 also includes a right arm motion module 1794and a left arm motion module 1796. The right and left arm motion modules1794 and 1796 are configured to activate movement of the left and rightarms of the simulator 1702. In some embodiments, the right and left armmodules 1794 and 1796 are particularly suited for use in a newborn sizedsimulator. In some embodiments, the right and left arm motion modules1794 and 1796 comprise pneumatic modules that are utilized to inflateand deflate air bags associated with the arms of the simulator. In thatregard, in some instances the air bags comprise accordion bags such thatas the bags are filled with air they expand outwardly in a predeterminedprofile. By inflating and deflating the bags with the modules, the armsof the simulator are moved. The bags are associated with a pivotassembly positioned adjacent the simulator's elbow in some instances. Inone particular embodiment, inflation and deflation of the bags causesthe simulator's arm to bend or straighten via the pivot assembly. Asmovement of the arms is actuated by a pneumatic module and the inflationand deflation of air bags, a user can restrain movement of the armswithout causing physical damage to the simulator in contrast to somemechanically actuated systems. In some embodiments, the arm motionmodules are configured to activate a mechanical system or motor formoving the simulator's arms. In some embodiments, the mechanical systemincludes a safety to prevent damage to the arm motion modules andassociated components if and when the intended arm motion is restrictedby a user.

The patient simulator 1702 also includes a rotation module 1798. Therotation module 1798 is configured to rotate the fetus or baby withinthe mother simulator. Particularly, the rotation module 1798 isconfigured to actuate a motor or other device for controlling therotation of the baby as it travels within the birth canal of the mothersimulator. The patient simulator 1702 also includes a load cell module180. In some embodiments, the load cell module 1800 is positioned on adelivery mechanism of the mother simulator and is configured to monitorthe amount of pressure being exerted on the baby during birthing. Inthat regard, the load cell module 1800 is positioned adjacent theattachment point of the baby to the delivery mechanism in someembodiments. In other embodiments, the load cell module 1800 ispositioned within or on the baby itself. Generally, the signalsgenerated by the load cell are communicated to the control system 1104via the master module 1706. Based on the sensed pressures or forces asmeasured by the load cell, a determination can be made regarding whetherthe amount of force being used in birthing the baby are within thedesired range.

The patient simulator 1702 also includes a tummy pressure module 1802.The tummy pressure module 1802 is utilized to control the firmness ofthe mother simulator's tummy. In that regard, the tummy pressure module1802 is configured to sense the amount of pressure within the mother'stummy. Based on a desired pressure, the tummy pressure module 1802determines whether pressure in the tummy should be increased, decreased,or remain the same. If the pressure should be increased, then the tummypressure module 1802 activates the flow of air to the tummy through apneumatic valve. In some embodiments, the tummy pressure module 1802 isin communication with an air reservoir or compressor for providing theair flow to the tummy. If the pressure should be decreased, then thetummy pressure module 1802 activates the release of air from the tummy.The desired pressure is provided by the control system 1104 in someinstances. In that regard, a user or teacher can define the tummypressure via the control system 1104 in some embodiments.

The patient simulator 1702 also includes a baby release module 1804. Thebaby release module 1804 is configured to selectively release the babyfrom the delivery mechanism within the maternal simulator. In thatregard, the baby release module 1804 is remotely activated by a user orteacher via the control system 1104 in some instances. In otherinstances, the baby release module 1804 is activated based on theposition of the delivery mechanism and/or baby within the birth canal.That is, once the baby reaches a certain position and/or orientationwith the birth canal the baby release module activates to release theengagement between the delivery mechanism and the baby.

The patient simulator 1702 also includes a tongue control module 1806.The tongue control module 1806 is a pneumatic module configured toselectively inflate and/or deflate the tongue to partially obstruct anairway of the simulator 1702. In that regard, the tongue control module1806 is controlled via the control system 1104 in some instances.Accordingly, a user or teacher can partially block or unblock the airwayas desired. The patient simulator 1702 also includes a larynges controlmodule 1808 and a pharynges control module 1810. The larynges controlmodule 1214 is configured to open and close the larynx to partiallyobstruct the airway of the simulator, to simulate a laryngespasm.Similarly, the pharynges control module 1216 is configured to urge theposterior wall of the pharynx anteriorly to partially obstruct theairway of the simulator, to simulate pharyngeal swelling. The laryngescontrol module 1808 and the pharynges control module 1810 are alsocontrolled via the control system 1104 in some instances. Accordingly, auser or teacher can also partially block or unblock the airway asdesired with these features as well.

The patient simulator 1702 also includes a pneumothorax module 1812 anda pneumothorax release module 1814. The pneumothorax module 1812 isconfigured to simulate the presence of a pneumothorax (collapsed lung)in the left lung or the right lung. The pneumothorax release module 1814is configured to return the simulator 1702 to normal lung conditionwithout a pneumothorax. The onset and alleviation of the pneumothoraxcondition is controlled via the control system 1104.

The patient simulator 1702 also includes eyelid module 1816. The eyelidmodule 1816 is configured to control the blinking of the patient's eyes.In some embodiments, the eyelid module 1816 includes modules forcontrolling the opening and closing of the eyelids to simulate blinking.Similarly, the rate, pattern, and speed of blinking are controlled bythe control system 1104 in some instances. In some instances the rate ofblinking ranges from 5 blinks per minute to 30 blinks per minute.However, ranges outside of this are used in some embodiments. Further,the eyes can be maintained in an open position or a closed position. Thespeed of the blinks can be controlled as well. In some instances, thespeed of each blink from open to closed to open is approximately 200 ms.However, the speed of the blinks can be increased or decreased asdesired in some embodiments.

The patient simulator 1702 also includes a right side seizure module1818 and a left side seizure module 1820. The right and left seizuremodules 1818 and 1820 are configured to simulate a seizure of thepatient on the corresponding sides of the patient's body. Accordingly,the seizure modules 1818 and 1820 are configured to cause shaking and/orconvulsing in some embodiments. Also, the seizure modules 1818 and 1820are used together in some instances to simulate a full body seizure. Insome instances activation of the seizure modules 1818 and 1820 iscontrolled via the control system 1104.

The patient simulator 1702 also includes a rotational encoder module1822 and a head encoder module 1824. The rotational encoder module 1822and the head encoder module 1824 are configured to provide rotationalpositional data regarding the baby within the birthing canal of amaternal simulator. In that regard, the rotational encoder module 1822and head encoder module 1824 are particularly configured to monitor therelative rotation of the baby within the birth canal. In someembodiments, the rotational encoder module 1822 is positioned on thedelivery mechanism of the maternal simulator and the head encoder module1824 is positioned within a portion of the baby. In some instances, thehead encoder module 1824 is positioned within the head of the baby. Therotation of the baby is determined by comparing the relative rotation ofthe head encoder module 1824 on the baby to the rotational encodermodule 1822. In some instances, the rotational encoder module 1822 issubstantially fixed rotationally. Based on the relative rotation of themodule 1824 compared to the module 1822 the rotational position of thebaby can be determined. In some embodiments the modules 1822 and 1824are optical modules. The rotational data from the modules 1822 and 1824is communicated to the control system 1104 in some embodiments. In onesuch embodiment, a user or teacher utilizes the positional androtational information to determine when to release the baby from thedelivery mechanism of the maternal simulator. In other embodiments, thecontrol system 1104 automatically releases the baby from the deliverymechanism based on a correct orientation and position of the baby withinthe birth canal.

The simulator 1702 also includes a right pupil dilation module 1826 anda left pupil dilation module 1828. In some embodiments, the pupildilation modules 1826 and 1828 control the dilation of each of thesimulator's eyes at least partially based on the amount of lightreceived by an optical sensor positioned within the eye. The maximumsize of the pupil and/or the rate of change or dilation of the pupil arecontrolled by the control system 1104 in some instances.

The patient simulator 1702 also includes a hemorrhage module 1832. Insome embodiments the hemorrhage module 1832 is configured for use inmaternal simulator. In that regard, hemorrhaging is a leading cause ofmaternal death. Although it is not unusual for a woman to lose 500 cc ofblood during or after delivery of the baby, the loss of more than aliter of blood can lead to shock and ultimately death. The patientsimulator is equipped with a reservoir containing simulated blood fromwhich the simulated blood can be pumped to simulate hemorrhaging. Inthat regard, the hemorrhaging module works in a manner substantiallysimilar to the right and left arm amputation modules 1758 and 1830described above. In maternal simulator applications, the amount ofbleeding and its flow rate are controlled via a flexible tube positionedbetween the reservoir and the birth canal. A user can stop the bleedingby applying appropriate pressure to deform the tubing and cutoff theflow of simulated blood.

Each of the various modules is connected to the master module 1706 via apower wire 1834, a ground wire 1836, and a 2-way communication wire1838. In that regard, the master module 1706 can control the activation,deactivation, and power consumption of each of the modules. In someembodiments, the master module 1706 is controlled via a software programof the control system 1104. In other embodiments, the modules aredirectly connected to a power supply. In some embodiments, the mastermodule 1706 is in wireless communication with one or more of themodules. In some embodiments, communication to one or more of themodules is 1-way communication. In some embodiments, the modulesthemselves are interconnected via the communication wire 1838 or anadditional communication wire. In that regard, in some instances anon-master module acts as a master module for a subset of modules.

In some embodiments the patient simulators of the present disclosure areconfigured for physiological simulation. In that regard, in someembodiments an external control system or other software-based interfaceis configured to adjust the various physical parameters of the patientsimulator based on a physiological simulation protocol. In someembodiments, the external control system includes a plurality of modelsincluding but not limited to a circulation model, respiratory model,myocardial infarction model, medication/pharmaceutical model,mother/fetus model, and/or other physiological models for controllingthe simulated physical parameters. The physiological models areconfigured for simulating various physiological situations and medicalconditions, such as heart attacks, decreased oxygen supply, and anyother desired medical conditions that may be simulated by the associatedpatient simulator. Several specific embodiments of physiologicalsimulation and physiological simulation models will now be described.

In one embodiment, physiological simulation is utilized with a maternalsimulator and a fetal simulator. For example, in some embodiments theeffect of an abnormal physical condition of the maternal simulator onthe fetal simulator is simulated by changing the physicalcharacteristics of the fetal simulator. Further, this effect ismaintained or established in the newborn simulator after the simulatedbirth of the fetal simulator. In some instances, a maternal/fetal modelgenerates a number of physiological outputs defining the physicalcharacteristics of the maternal simulator and the fetal simulator. Thesephysiological outputs are received by a master module of the simulatorsand the corresponding physical characteristics are then simulated. Insome instances the physiological outputs include the maternal bloodoxygenation. The level of maternal blood oxygenation relates to thefetal heart rate and how changes in fetal heart rate correspond tocontractions of the maternal simulator. High levels of oxygenationrelate to normal fetal heart rates and reassuring patterns of fetalheart tones. However, low levels of oxygenation relate to low heartrates and ominous patterns, such as variable decelerations. Further, thematernal blood oxygenation also relates to the level of oxygenation ofthe fetus. In particular, a low maternal blood oxygenation level signalsthat the fetus will be receiving a low amount of oxygen through theplacenta. The level of fetal oxygenation relates to the well being ofthe newborn. A fetus that is well oxygenated throughout the deliveryprocess usually exhibits good posture, good muscle tone, a heartrate inexcess of 100 beats a minute, good color, and good breathing as anewborn. These 5 elements—posture, muscle tone, heart rate, color, andbreathing—are used to estimate the APGAR score for a newborn. The APGARscore is normally determined 1 minute after birth, 5 minutes afterbirth, and if necessary at five minute intervals thereafter.

Accordingly, the maternal/fetal model provides physiological outputsthat correlate the physical parameters of the maternal and fetalsimulators to one another. In addition, characteristics of the fetalsimulator are carried on to the newborn in some instances. The newbornis designed to exhibit these physical characteristics and, in someembodiments, can simulate a newborn exhibiting an APGAR score from 0 to10. In this manner, the maternal simulator's wellbeing is transferred tothe fetal simulator which is then transferred to the neonate. In thatregard, in some embodiments the fetal simulator and the newborn orneonatal simulator are the same simulator. In other embodiments, thefetal simulator and the newborn simulator are separate simulators.

In addition to correlating the physical parameters of the maternal andfetal simulators to one another, the physiological modeling is alsoconfigured to correlate physical parameters within a single simulator.For example, in some embodiments the physical parameters of thesimulator are adjusted based on the treatment provided to the simulatorby a user. If the appropriate treatment is provided, then the physicalparameters of the simulator improve. However, if the treatment is notadequate, then the physical parameters of the simulator stay the same orget worse. The particular interaction between the treatment and thephysical parameters of the simulator are driven by the physiologicalmodel. In that regard, in some instances the physiological modelutilizes data received from the modules within the simulator todetermine whether the treatment is appropriate. For example, the amountof pressure as sensed by a chest compression module or a ventilationmodule is utilized in some instances to determine whether the level oftreatment is appropriate. Further, in some embodiments the physicalparameters of the simulator are extended from one area of the simulatorto another. For example, in some instances the respiratory system of thesimulator indicates that the simulator has low oxygenation and if thisproblem is not adequately addressed through appropriate treatment, thenthe respiratory problem is extended to a problem in the simulatedcirculatory system. In that regard, the various physiological models arein communication with one another in some instances. The specificinteractions between the various portions of the simulator are definedaccording to the natural physiological interactions within the body insome instances. In some instances, these interactions are defined atleast partially based on medical studies and/or published papersregarding such interactions.

In some embodiments, the physiological modeling includes a circulationmodel. The circulation model is configured to control the simulatedphysical parameters of the circulatory system of the patient simulator.In that regard, the circulation model controls the blood pressure, heartrate, blood oxygenation, K-sounds, and/or other parameters of thecirculatory system. In some instances, the circulation model controlsthe physical parameters within various compartments or regions of thepatient simulator. In that regard, in some instances the circulatorysystem is divided into a plurality of regions, including but not limitedto the 4 chambers of the heart. Further, in some embodiments thephysiological modeling includes a myocardial infarction model. In someinstances, the myocardial infarction model is part of the circulatorymodel. The myocardial infarction model is configured to control aspectsof the circulatory system associated with a heart attack, including butnot limited to the supply of oxygen to the heart. In some instances, themyocardial infarction model controls the specific location of themyocardial infarction. Further, in some instances the myocardialinfarction model controls the ECG module of the patient simulator suchthat the ECG module emits electrical signals corresponding to themyocardial infarction, including but not limited to the location and/orseverity of the problem.

In some embodiments, the physiological modeling includes a respiratorymodel. The respiratory model is configured to control the simulatedparameters of the respiratory system of the patient simulator. In thatregard, the respiratory model controls the respiratory rate, inspirationrate, lung sounds, O₂/CO₂ mixture, and/or other parameters of therespiratory system. In some embodiments, the physiological modelingincludes a medicinal or pharmaceutical model. In some instances thepharmaceutical model is configured to integrate with other models and/ormodules to modify the simulated parameters of the patient simulatorbased on the effects associated with introducing a pharmaceutical to thepatient. In that regard, in some instances the pharmaceutical modelmaintains a database of the physical effects associated with aparticular pharmaceutical. Accordingly, the pharmaceutical model trendsor adjusts the parameters of the patient simulator based on the effectsof the pharmaceutical. The rate of change of the parameters is based onthe effects of the pharmaceutical in some instances. In some instances,the pharmaceutical model allows a user to define the effects of thepharmaceutical.

In some embodiments, the physiological modeling comprises a plurality ofscenarios. In that regard, each scenario is defined by a particulargrouping or sets of parameters. In some instances the scenario includesparticular circulatory and respiratory parameters associated with amedical problem. Accordingly, a scenario integrates the features of thevarious physiological models in some instances. In some embodiments, thephysiological modeling is configured to trend between scenarios. In thatregard, a user or teacher establishes a predetermined series ofscenarios. The user defines the length of time for each scenario and theamount of transition time between scenarios in some embodiments. In someembodiments, the series of scenarios is at least partially modifiedbased on the treatment administered to the patient simulator. In thatregard, the parameters of the patient simulator improve or decline atleast in part based on the treatment administered. In some embodiments,at least some of the scenarios are predefined or provided by thephysiological simulation models. In some embodiments, at least some ofthe scenarios are user defined. That is, a user can associate aplurality of parameters and define a scenario. Further, a user canassociate plurality of scenarios—predefined or user defined—as anadditional scenario.

Referring now to FIG. 45, shown therein is a diagrammatic schematic viewof a patient simulator system 1900 according to one embodiment of thepresent disclosure. In particular, the system 1900 includes a patientsimulator 1902 including a plurality of modules particularly suited forbirthing simulation. In that regard, the simulator 1902 includes acombination of select modules described with respect to FIG. 44 above.In that regard, the patient simulator 1902 includes the master module1706, communication module 1708, antenna 1710, battery 1718, and charger1720. In addition to these components, the simulator 1902 includes thevoice module 1724, the delivery module 1726, the FHR sound module 1728,breathing valve module 1728, heart sound module 1740, bilateral pulsemodule 1752, ECG module 1736, ventilation module 1738, compressionmodule 1756, K-sound modules 1776 and 1778, lung sound modules 1760 and1762, blood pressure cuff modules 1780 and 1782, compressor controlmodule 1784, intubation module 1798, rotational module 1798, load cellmodule 1800, tummy module 1802, release module 1804, larynges module1808, seizure module 1819 (a combination of left and right seizuremodules 1818 and 1820 in some embodiments), rotational encoder module1822, and head encoder module 1824.

Referring now to FIGS. 46-49, shown therein is an eye assembly 2000according to one embodiment of the present disclosure. In particular,FIG. 46 is a front view of the eye assembly 2000; FIG. 47 is a frontview of an iris diaphragm of the eye assembly 2000; FIG. 48 is a bottomview of the eye assembly 2000; and FIG. 49 is a diagrammatic schematicview of the blinking assembly of the eye assembly 2000. Referring morespecifically to FIG. 46, the eye assembly 2000 includes a left eye 2002and a right eye 2003. The left and right eyes 2002 and 2003 are sized,shaped, and colored to simulate a natural patient's eyes. In thatregard, the eyes 2002, 2003 include eyelids 2004 and a simulated irisassembly 2006 that is configured to dilate in a similar manner to anatural eye. In that regard, in some embodiments the diameter of thepupils is adjustable from 1 mm to 8 mm. In some instances, the maximumdiameter of the pupils is established by a control system incommunication with the eye assembly 2000. In that regard, a user orteacher is able to set the pupil size in some embodiments via thecontrol system.

The eye assembly 2000 includes a servo motor 2008 that is incommunication with or directly connected to a wheel 2010. The wheel 2010in turn is in communication with or directly connected to amicrofilament line 2012 that is communication with or directly connectedto the iris assembly 2006. In particular, the microfilament line 2012 isin communication with or directly connected to a pin 2014 of the irisassembly 2006. Referring more particularly to FIG. 47, the pin 2014 ismoveable relative to an outer portion 2016 of the iris assembly 2006such that an inner portion 2018 expands and contracts radially withcorresponding movement of the pin 2014. In some embodiments, the pin2014 moves left or right around the outside of the outer portion 2016 asshown in FIG. 47 to adjust the size of the visible portion of the innerportion 2018.

In some embodiments, the eye assembly 2000 includes an optical sensorthat is associated with each eye 2002 and 2003. Based on the amount oflight received by the optical sensor the servo motor 2008 is activatedto increase or decrease the amount of the inner portion of the irisassembly that is visible. The greater the amount of the inner portion2018 that is visible, the smaller the simulated pupil of the eye.Similarly, the lesser the amount of the inner portion 2018 that isvisible, the larger the simulated pupil of the eye will appear. In thismanner, pupil dilation is simulated by the eye assembly 2000. In someinstances, the rate of change or responsiveness of the iris assembly canbe slowed to simulate an abnormal medical condition that would result inslowed pupil dilation.

Referring more particularly to FIGS. 48 and 49, the eye assembly 2000configured to simulate blinking of the patient. In particular, theeyelids 2004 of the eyes 2002 and 2003 are opened and closed to simulateblinking. In the present embodiment, the eye assembly 2000 utilizes apneumatic system to simulate the blinking of the eyes. In particular,the eye assembly 2000 includes an opening bag 2020, a middle plate 2022,and closing bags 2024. The middle plate 2022 is connected to the eyelids2004 via followers 2026 such that, as the middle plate translates due tothe inflation and deflation of the bags 2020 and 2024, the eyelids openand close. A spring 2028 is also included in some embodiments tofacilitate faster closing and opening of the eyelids 2004. When theopening bag 2020 is inflated the middle plate 2022 is forced away fromthe eyes and the eyelids 2004 are held open. When the closing bags 2024are inflated the middle plate 2022 is forced towards the eyes and theeyelids 2004 of the eyes are closed. Accordingly, the bags 2020 and 2024can be activated in sequence to simulate blinking.

Referring more specifically to FIG. 49, shown therein is a schematic ofthe blinking assembly of the eye assembly 2000. In that regard, theblinking assembly is in communication with an air reservoir orcompressor 2030 for inflating the bags 2020 and 2024. In that regard, acontrol board 2032 controls the opening and closing of a valve 2034associated with the opening bag 2020. Similarly, a control board 2036controls the opening and closing of a valve 2038 associated with theclosing bags 2024. In some embodiments the control boards 2032 and 2036are in communication with or directly connected to a master module ofthe simulator. In such embodiments, the master module directs thecontrol boards 2032 and 2036 when to open and close the valves 2034 and2038 respectively. In some embodiments the rate, pattern, and/or speedof blinking are controlled by a control system in communication with themaster module. In some instances the rate of blinking ranges from 5blinks per minute to 30 blinks per minute. However, ranges outside ofthis are used in some embodiments. Further, the eyelids 2004 can bemaintained in an open position or a closed position if desired. Thespeed of the blinks can be controlled as well. In some instances, thespeed of each blink from open to closed and back to open isapproximately 200 ms. However, the speed of the blinks can be increasedor decreased as desired in some embodiments.

Referring now to FIG. 50, shown therein is a diagrammatic perspectiveview of a delivery mechanism 2100 for use in a patient simulatoraccording to one embodiment of the present disclosure. In particular,the delivery mechanism 2100 is configured for selectively rotating afetal simulator, releasing the fetal simulator, and/or monitoring theforce exerted on the fetal simulator as it travels through the birthcanal. In some embodiments the delivery mechanism 2100 is configured tomonitor the force exerted on the fetal simulator by a student or medicalpersonnel during a simulated birth. The delivery mechanism 2100 includesa mounting plate 2102. The mounting plate 2102 is connected to a portionof the maternal simulator. In some embodiments, the mounting plate isconnected via portion 2104 to a delivery mechanism configured totranslate along the birth canal. In such embodiments, the deliverymechanism 2100 is configured to provide rotational movement to the fetusas the translational delivery mechanism translates the fetus along thebirth canal.

The delivery mechanism 2100 includes a motor 2106. In some embodiments,the motor 2106 is configured to provide a rotational movement the fetalsimulator. In other embodiments, the motor 2106 is configured to providetranslational movement to the fetal simulator in addition to or in lieuof the rotational movement. In some embodiments, the delivery mechanism2100 includes a potentiometer 2108 for monitoring the rotationalmovement of the fetal simulator. The potentiometer is connected to gear2110 via gear 2112. As shown gear 2110 surrounds a swivel base 2114 suchthat as the swivel base 2114 rotates the gear 2110 rotates as well. Theswivel base 2114 is associated with a swivel 2116 and swivel cap 2118configured for imparting rotation to the fetal simulator. In someembodiments, the motor 2106 drives the swivel system causing the swivel2116, swivel cap 2118, and swivel base 2114 to rotate. Accordingly, asthe motor 2106 rotates the swivel components, the gear 2110 is alsorotated causing gear 2112 to rotate. The rotation of gear 2112, in turn,is monitored by the potentiometer to determine the amount of rotation ofthe fetal simulator.

The delivery mechanism 2100 also includes a load cell 2120 and load cellsupports 2122 for monitoring the force exerted on the fetal simulatorduring the birthing simulation. In that regard, the fetal simulator issecurely attached to the delivery mechanism via attachment mechanism2124. In some embodiments, the attachment mechanism 2124 is similar tothat described with respect to FIGS. 24-27 above. Further, in someembodiments the engagement and disengagement of the fetal simulator tothe attachment mechanism is controlled by a pneumatic valve locatedwithin the delivery mechanism 2100. In some embodiments, the pneumaticvalve is controlled via a control system. Accordingly, in someembodiments a user or teacher can selectively release the fetalsimulator from the attachment mechanism 2124. The secure connectionbetween the fetal simulator and the attachment mechanism 2124 allowsforces exerted on the fetal simulator to be transferred through theattachment mechanism and to the load cell 2120. In some embodiments, theload cell supports 2122 are positioned on either side of the load cell2120 to prevent unwanted movement of the load cell. The amounts offorce, torque, pressure, and/or derivatives thereof measured by the loadcell 2120 are communicated to a control system in some embodiments.These measurements are then compared to an accepted standard to evaluatewhether an appropriate amount of force was used in the birthingsimulation.

Referring now to FIG. 51, shown therein is a delivery mechanism 2200according to another aspect of the present disclosure. In particular,the delivery mechanism 2200 is configured for selectively rotating afetal simulator, releasing the fetal simulator, and/or monitoring theforce exerted on the fetal simulator as it travels through the birthcanal. In some embodiments the delivery mechanism 2200 is configured tomonitor the force exerted on the fetal simulator by a student or medicalpersonnel during a simulated birth. The delivery mechanism 2200 includesa mounting plate 2202. The mounting plate 2202 is connected to a portionof the maternal simulator. In some embodiments, the mounting plate isconnected via portion 2204 to a delivery mechanism configured totranslate the delivery mechanism 2200 and/or the fetal simulator alongthe birth canal. In such embodiments, the delivery mechanism 2200 isconfigured to provide rotational movement to the fetus as thetranslational delivery mechanism translates the fetus along the birthcanal.

The delivery mechanism 2200 includes a motor 2206. In some embodiments,the motor 2206 is configured to provide a rotational movement the fetalsimulator. In other embodiments, the motor 2206 is configured to providetranslational movement to the fetal simulator in addition to or in lieuof the rotational movement. In some embodiments, the delivery mechanism2200 includes a sensor 2208 for monitoring the rotational movement ofthe fetal simulator. In some embodiments the sensor 2208 is similar tothe rotation encoders 1228, 1336, and/or 1822 described above. Thesensor 2208 is positioned adjacent to a swivel base 2214. The swivelbase 2214 is associated with a swivel 2216 and swivel cap 2218configured for imparting rotation to the fetal simulator. In someembodiments, the motor 2206 drives the swivel system causing the swivel2216, swivel cap 2218, and swivel base 2214 to rotate.

The delivery mechanism 2200 also includes a load cell 2220 and load cellsupports 2222 for monitoring the force exerted on the fetal simulatorduring the birthing simulation. In that regard, the fetal simulator issecurely attached to the delivery mechanism via attachment mechanism2224. In some embodiments, the attachment mechanism 2224 is similar tothat described with respect to FIGS. 24-27 above. In the currentembodiment, a power and communication connector 2226 is positionedadjacent to the attachment mechanism such that when the fetal simulatoris engaged with the attachment mechanism the power and communicationconnector 2226 engages a connector of the fetal simulator to providepower and data transfers to the fetal simulator. In some embodiments,the communication connector 2226 is configured for 2-way communicationwith the fetal simulator. Also, in some embodiments a portion 2228 ofthe attachment mechanism 2224 serves as a ground for the connector 2226.In some embodiments the engagement and disengagement of the fetalsimulator to the attachment mechanism is controlled by a pneumatic valvelocated within the delivery mechanism 2200. In some embodiments, thepneumatic valve is controlled via a control system. Accordingly, in someembodiments a user or teacher can selectively release the fetalsimulator from the attachment mechanism 2224. The secure connectionbetween the fetal simulator and the attachment mechanism 2224 allowsforces exerted on the fetal simulator to be transferred through theattachment mechanism and to the load cell 2220. In some embodiments, theload cell supports 2222 are positioned on either side of the load cell2220 to prevent unwanted movement of the load cell. The amounts offorce, torque, pressure, and/or derivatives thereof measured by the loadcell 2220 are communicated to a control system in some embodiments.These measurements are then compared to an accepted standard to evaluatewhether an appropriate amount of force was used in the birthingsimulation.

Although illustrative embodiments have been shown and described, a widerange of modification, change, and substitution is contemplated in theforegoing disclosure and in some instances, some features of the presentembodiment may be employed without a corresponding use of the otherfeatures. It is understood that such variations may be made in theforegoing without departing from the scope of the embodiment.Accordingly, it is appropriate that the appended claims be construedbroadly and in a manner consistent with the scope of the presentdisclosure.

What is claimed is:
 1. A newborn simulator for teaching patient care,the simulator comprising: a body sized to simulate a newborn baby; asimulated heart positioned within the body for providing a simulatedheart beat; simulated lungs positioned within the body for providing asimulated respiratory pattern; and at least one actuator positionedwithin a portion of the simulator and operable for controlling at leasta portion of the simulated heart and the simulated lungs such that thesimulated heart and lungs are operable to provide the simulated heartbeat and respiratory pattern without physical connection to a devicepositioned outside the body.
 2. The simulator of claim 1, wherein the atleast one actuator includes a compressor.
 3. The simulator of claim 2,wherein the compressor is configured to control at least a portion ofthe simulated lungs.
 4. The simulator of claim 2, wherein the compressoris configured to control at least a portion of the simulated heart. 5.The simulator of claim 4, wherein the compressor is connected to asimulated circulatory system.
 6. The simulator of claim 5, wherein thecompressor is further configured to provide a simulated pulse to thesimulated circulatory system.
 7. The simulator of claim 6, furthercomprising a mechanism for simulating cyanosis.
 8. The simulator ofclaim 1, wherein the compressor is configured to control at least aportion of both the simulated heart and the simulated lungs.
 9. Thesimulator of claim 1, wherein the compressor is positioned within a headportion of the body.
 10. The simulator of claim 1, further comprising asound dampening arrangement connected to the actuator to suppress noisegenerated by the actuator.
 11. The simulator of claim 10, wherein themuffler system includes a first layer made of an acoustic barriermaterial and a second layer made of a mass barrier material.
 12. Thesimulator of claim 1, further comprising an output device forcommunicating simulator information to an external device.
 13. Thesimulator of claim 12, wherein the output device is configured forwireless communication with a control system.
 14. The simulator of claim13, wherein the newborn simulator is configured to receive commands fromthe control system wirelessly.
 15. The simulator of claim 1, wherein thebody comprises a pair of moveable arms.
 16. The simulator of claim 15,wherein the pair of arms are configured for multiple types of movement.17. The simulator of claim 16, wherein the multiple types of movementinclude movements selected from the group consisting of limp, normal,and convulsions.
 18. The simulator of claim 17, wherein the movementsare at least partially actuated pneumatically by an arm-movement driver.19. The simulator of claim 15, wherein a muscle tone of the pair of armsis selectable.
 20. The simulator of claim 19, wherein adjustment in themuscle tone of the pair of arms is at least partially actuatedpneumatically.